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Pkactioal  Massage 

AND 

COKREGTIVE  EXERCISES 


BY 

HAETYIG  NISSElsr 

Prrsidcnt    of    Posse    Normal    School    of    Gymnastics;    Superintendent    of 
llosijital    Clinics   in    Massage   and    Medical    Gymnastics;    For    Twenty- 
lour     years     Lecturer     and     Instructor     of     Massage     and     Swedish 
Gymnastics     at     Harvard     University     Summer     School;     Late 
Director    of    Physical    Training    at    Boston    and    Brookliue 
Public  Schools:    Former  Instructor  of  Physical   Training 
at  Johns  Hopkins   University   and   Wellesley  College, 
Former  Director  of  the  Swedish  Health  Institute, 
Washington,   D.   C,   etc.;   author  of  "Swedish 
Movements     and      Massage      Treatment," 
"Practical    Massage    in    Twenty    Les- 
sons," "A.   B.   C.   of  Swedish  Edu- 
cational Gymnastics,"  "Rational 
Home    Gymnastics,"    etc. 


REVISED  AND  ENLARGED  EDITION  OF  THE  AUTHOR'S 

"PRACTICAL  MASSAGE  IN  TWENTY  LESSONS," 

WITH  MANY  ADDITIONS. 


With  68  Original  Illustrations,   Including  Several  Full- 
page  Half-tone  Plates, 


PHILADELPHIA 

F.  A.  DAVIS  COMPANY,  Publishers 

English  Depot 

Stanley  Phillips,  London 

1916 


COPYRIGHT,   1905 
COPYRIGHT,   1916 


F.   A.    DAVIS   COMPANY 
Copyright,  Great  Britain.     All   Rights   Reserved 


Philadelphia,  Pa.,  U.  S.  A. 

Press  of  F.  A.  Davis  Company 

1914-16  Cherry  Street 


PREFACE  TO  REVISED  EDITION. 


As  years  roll  by  there  are  constantly  new  theories 
and  methods  coming  up,  and  my  own  exjx^rience 
teaches  me,  more  and  more,  one  is  never  too  old  to 
learn ;  so  1  have  found  it  necessary  to  enlarge  and  im- 
prove on  my  former  books,  and  also  to  add  the  im- 
portant "Corrective  Exercises,"  with  full  description 
of  their  effect  and  muscles  used  in  the  different 
movements. 

This  new  book,  then,  is  what  forty  years  O'f  study 
and  experience,  practice,  and  teaching  have  taught  me ; 
and  I  earnestly  hope  it  will  be  of  value  to  those  who 
wish  to  learn  in  a  practical  way  to  treat  suffering  hu- 
manity v.'ith  Mechanotherapy. 

Hartvig  Nissen. 
Boston,  Mass. 


(iii) 
357331 


rf; 


PREFACE  TO  FIRST  EDITION. 


Since  my  book,  "Swedish  Movement  and  Mas- 
sage Treatment,"  was  piublished  in  May,  1889,  I  have 
had  many  hundreds  oif  pupils  as  well  as  patients;  and 
during  my  thirty  years  of  experience  as  a  masseur  and 
teacher,  I  have  been  constantly  studying  and  practis- 
ing and  broadening  my  views  and  ideas. 

My  first  book  was  written  on  the  authority  of  others 
and  the  theory  which  they  taught. 

This  book,  which  I  hope  will  be  found  worthy  of 
its  title,  "Practical  Massage,"  is  the  result  of  my  life's 
work. 

It  is  written  just  as  I  have  been  teaching  "mas- 
sage" for  several  years  at  Harvard  University  Summer 
School  and  to  my  private  pupils. 

My  method  is  a  combination  of  what  I  have  found 
to  be  the  best  and  most  useful  "manipulations"  and 
"movements"  in  other  systems  as  well  as  original.  I 
trust  this  little  book  will  be  accepted  as  a  practical  help 
in  the  treatment  of  the  sick. 

Hartvig  Nissen. 
Boston,  Mass. 


(iv) 


CONTENTS. 

CHAPTER   1.  PAGE 

The  History — Swedish  Movement  Treatment — A  Word 
to  the  Physician — Variety  of  Movements  and  Dura- 
tion— How  Often  the  Treatment  Should  be  Repeated 
— How  to  be  Dressed — Physiological  Effects  of  Move- 
ments— Passive  Movements — Active  and  Resistive 
Movements    1-18 

CHAPTER    II. 
Active    and    Passive    Movements — Resistive    or    Duplicate 
Movements — The    Positions — Manipulations   of   Arms 
— Centripetal   Stroking,  Kneading  and  Circular  Fric- 
tion— The  Effects  of  These   Manipulations 19-29 

CHAPTER    III. 
Manipulations     of     Arms— Nerve     Compression — Muscle 
Rolling — Slapping — Friction— Combination      Kneading 
— Percussion — Beating — \'ibration    30-36 

CHAPTER  IV. 
Passive  Movements  of  Arms — Finger  Rotation — Hand 
Rotation — Forearm  Rotation — Arm  Rotation  (Smgle) 
— Flexion  of  Arm,  Hand,  and  Finger — Vertical  Arm 
Rotation — Forward  Arm  Rotation — Shoulder  Rota- 
tion and  Chest  Lifting 37-43 

CHAPTER  V. 
Manipulations  of  Legs — Centripetal  Stroking.  Kneading, 
and  Circular  Friction — Xerve  Compression,  Muscle 
Rolling,  Slapping,  and  Friction — Combination  Knead- 
ing— Percussion — Beating — ^\'''ibration — Stretching  the 
Sciatic  Nerve — Passive  Movements  of  Legs :  Foot 
Rotation     (Single    and    Double) — Foot    Flexion    and 

Extension — Thigh  Rotation — Hip  Rotation 44-48 

(v) 


vi  CONTENTS. 

CHAPTER  VI.  PAGE 
Passive  Movements  of  the  Trunk:  Manipulations  of  the 
Chest- — Chest  Friction  and  Kneading — Chest  Vibra- 
tion— Chest  Slapping — Chest  Lifting  and  Vibration — 
Abdominal  Massage  :  Stomach  Friction — Muscle 
Kneading  of  the  Abdomen — Knuckle  Kneading  of  the 
Abdomen— Circular  Kneading  of  the  Abdomen — ■ 
Stomach  Vibration — Bowel  Vibration — Bowel  Concus- 
sion— Loin  Vibration — Loin  Traction 49-57 

CHAPTER  VH. 
Massage  of  the  Back :  Back  Friction — Back  Muscle 
Kneading,  Muscle  Rolling — Back  Circular  Kneading 
— Back  Vibration — Spinal  Nerve  Compression — Back 
Percussion — Long  Friction  Down  the  Back — Breech 
Beating  58-63 

CHAPTER  VHL 
Head,  Face,  and  Throat  Massage — Head  Percussion — 
Vibration  at  the  Base  of  the  Skull — Kneading  of  the 
Head — Head  Vibration — Friction  of  the  Forehead  and 
Temples — Facial  Massage — Throat  Massage — Head 
Rotation — Head   Flexion    (Passive) 64-71 

CHAPTER  IX. 
Resistive  Movement  of  Arms :  Finger  Flexion  and  Ex- 
tension— Hand  Flexion  and  Extension — Arm  Flexion 
and  Extension — Vertical  Arm  Flexion  and  Extension 
— Horizontal  Arm  Flexion  and  Extension — Horizontal 
Arm  Separation  and  Closing — Lateral  Arm  Elevation 
and  Depression — Forward  Arm  Traction — Arm  Tor- 
sion     

CHAPTER    X. 

Resistive  Leg  Movements  :    Foot  Flexion  and  Extension — 

Leg  Flexion  and   Extension — Upward  Knee   Traction 

— Knee    Flexion    and    Extension — Leg    Elevation    and 

Depression — Backward  Leg  Traction — Leg  Separation 


72-79 


CONTENTS.  vii 

PAGE 

and    Closing — Bent    Knee    Separation    and    Closing — 

Leg  Torsion  80-87 

CHAPTER   XI. 

Passive  and  Resistive  Movements  of  the  Trunk :  Trunk 
Rotation — Trunk  Torsion  (Sitting  and  Kneeling)  — 
Forward  Trunk  Mcxion  and  Extension — Neck  Flex- 
ion and  Extension   88-91 

CHAPTER    Xn. 
Corrective  Active  Exercises  of  Arms:    Standing  Position 
— Shoulder  Circling — Arm  Circling — Arm  Elevation — 
Arm     Flinging — Arm     Rotation — Arm     Flexion     and 
Extension    92-96 

CHAPTER  Xni. 
Corrective  Active  Exercises,  of  Legs:  Leg  Elevation, 
Sideways — Leg  Elevation,  Forward — Leg  Elevation, 
Backward — Knees  Bend — Heel  Elevation — Charge,  or 
Fall  Out,  Forward — Horizontal  Balance,  Standing — 
Back  Curving — Leg  Elevation,  Lying 97-101 

CHAPTER  XIV. 
Corrective  Active  Exercises  of  Head  and  Trunk :  Head 
Bending,  Backward — Trunk  Flexion,  Backward  and 
Forward — Chopping  Movement — Harvesting  Move- 
ment— Trunk  Flexion.  Sideways — Trunk  Torsion — 
Trunk  Circling — Trunk  Elevation,  Lying — Body  Hori- 
zontal on  Toes  and  Hands 102-108 

CHAPTER    XV. 
Stiffness  of  Joints  and  Tendons — The  Modus  Operandi — 
The  Knee  Joint — My  Method — Mistake  to  Apply  Mas- 
sage    Too     Long    at    a    Time — Sprains,     Synovitis — 
Hydrarthrus    109-1 18 

CHAPTER    XVI. 
Flat-foot:    "Morbid  Condition  of  Foot  in  Which  the  Arch 

is   Destroved"   119-122 


viii  CONTENTS. 

CHAPTER   XVII.  PAGE 

General  Massage — My  Advice  to  Newcomers — Neuras- 
thenia— Prescription  I — Prescription  II — Prescription 
III — "High    Blood-pressure" — "Arteriosclerosis" 123-132 

CHAPTER   XVIII. 
Hysteria  and  Hypochondria — Chlorosis  and  Anemia — In- 
somnia— Diabetes   Mellitus    133-142 

CHAPTER   XIX. 
Local  Diseases:    Diseases  of  the  Brain,  Spinal  Cord,  and 
Nerve — Congestion     of    the     Brain — Anemia    of     the 
Brain — Paralysis  as  a  Result  of  Apoplexy 143-149 

CHAPTER   XX. 
Local    Diseases :     Congestion    of    the    Spine — Locomotor 

Ataxia  , 150-152 

CHAPTER   XXI. 
Infantile   Paralysis,   "Poliomyelitis   Anterior" 153-158 

CHAPTER    XXII. 
Occupation    Neuroses — Writers'    Cramp — Cramp    of    the 

Legs — Chorea   159-162 

CHAPTER   XXIH. 
Sciatic  Neuralgia   163-170 

CHAPTER   XXIV. 
Diseases  of  the  Organs  of  the  Circulation :    Chronic  Heart 

Disease — Diseases  of  the  Respiratory  Organs 171-178 

CHAPTER   XXV. 
Diseases  of  the   Organs  of   Digestion  :     Dyspepsia — Con- 
stipation— Hyperemia     of     the     Liver — Appendicitis — 
Indigestion     and     Biliousness — Obesity — Diseases     of 
Urinary  and  Sexual  Organs:    Chronic  Catarrh  of  the 


CONTENTS.  i'x 

PAGE 

Bladder — Chronic  Catarrh  of  the  Womlj — Displace- 
ment of  the  Womb — Irrigularity  and  Painful  Men- 
struation     179-186 

CHAPTER   XXVr. 

Diseases  of  the  Organs  of  Movement:  Scoliosis,  "Lateral 
Curvature  of  the  Spine" — "Lordosis" — "Kyphosis" — 
"Pigeon-breast" — "Round    Shoulders"    187-196 

CHAPTER   XXVH. 
Rheumatism,     "Myitis" — Muscular     Rheumatism,     of     the 
Right  Arm,  of  the  Neck — Lumbago — Rheumatism  of 
the  Joints,  "Arthritis"    197-205 


LIST  OF  ILLUSTRATIONS. 


PAGE 

1.  Centripetal    Stroking    22 

2.  Muscle  Kneading  of  Fingers   23 

3.  Muscle  Kneading  of  Ann   24 

4.  Circular   Kneading    25 

5.  Circular   Friction   26 

6.  Nerve  Compression    30 

7.  Muscle    Rolling    31 

8.  Percussion    33 

9.  Beating    34 

10.  Arm  Vibration   35 

11.  Forearm   Rotation   3fi 

12.  Vertical   Arm    Rotation   4U 

13.  Forward  Arm   Rotation    41 

14.  Shoulder  Rotation  and  Chest  Lifting   43 

15.  Foot  Rotation    ( Double )    46 

16.  Thigh  Rotation    47 

17.  Chest  Lifting  and   Viliration    51 

18.  Muscle  Kneading  of  the  Abdomen   52 

19.  Knuckle  Kneading  of  the  Abdomen   S3 

20.  Circular  Kneading  of  the  Abdomen    54 

21.  Loin  Vibration  55 

22.  Back  Muscle  Kneading 59 

23.  Back    Percussion    60 

24.  Breach  Beating    62 

25.  Veins  of  Head  and  Neck 68 

26.  Vertical  Arm  Flexion  and  Extension   73 

27.  Horizontal  Arm  Flexion  and   Extension    75 

28.  Horizontal  Arm  Separation  and  Closing  76 

29.  Lateral  Arm  Elevation  and  Depression   77 

30.  Forward  Arm  Traction    (Lying)    78 

31.  Leg  Flexion  and  Extension    80 

32.  Upward  Knee  Traction    81 

33.  Knee  Flexion  and  Extension   82 

(xi) 


xii  LIST  OF  ILLUSTRATIONS. 

PAGE 

34.  Leg  Elevation  and   Depression    84 

35.  Backward   Leg  Traction 85 

36.  Bent  Knee  Separation  and  Closing  86 

ZT.  Trunk  Torsion    (Kneeling)    89 

38.  Forward  Trunk  Flexion  and  Extension   90 

39.  Standing   Position   92 

40.  Arm   Circling   92 

41.  Arm  Elevation   (Forward.  Upward)    92 

42.  Arm  Flinging    (Sideways)    92 

43.  Arm  Rotation     92 

44.  Arm  Flexion    (and  Extension)    92 

45.  Arm   (Flexion)   and  Extension,  Upward   92 

46.  Leg  Elevation,   Sideways    100 

47.  Leg  Elevation,   Forward   100 

48.  Leg  Elevation,   Backward  100 

49.  Knees  Bend    (Deep)    100 

50.  Charge,  or  Fall  Out,  Forward   100 

51.  Charge,  or  Fall  Out.  Forward  (Side  View)    100 

52.  Horizontal  Balance    ( Standing)   100 

53.  Back  Curving  100 

54.  Leg  Elevation   (Lying)    100 

55.  Trunk  Flexion   (Backward)    104 

56.  Trunk  Flexion    (Forward)    104 

57.  Trunk  Flexion    (Forward)    104 

58.  Harvesting  Movement  104 

59.  Harvesting  Movement   104 

60.  Trunk   Flexion    (Sideways)    104 

61.  Trunk  Torsion   104 

62.  Trunk  Elevation    (Lying)    107 

63.  Body   Horizontal' 104 

64-69.  Curvature  of  the  Spine  191-195 


PRACTICAL  MASSAGI^:  AND  CORRECTIVE 
EXERCISES. 


CHAPTER    I. 


Massage  is  a  very  much  misinterpreted  word  and 
frequently  erroneously  used,  sometimes  intentionally, 
but  often  1)y  mistake.  It  means  kneading,  or  a  me- 
chanical action — a  handling  and  manipulating — of  the 
flesh,  as  in  stroking,  pressing,  kneading,  percussing, 
etc.,  for  a  therapeutical  pui-pose. 

In  certain  cases  massage  proper  is  all  which  is 
needed,  but  very  frequently  it  must  be  used  together 
with  passive  and  resistive  exercises,  and  in  such  cases 
massage  becomes  a  part  of  Medical  Gymnastics, 
Mechanotherapy,  Swedish  IMovements,  or  whatever 
name  one  prefers  to  give;  they  all  mean  the  same 
thing'.  The  attempts  made  by  certain  authors  to 
separate  massage  from  medical  gymnastics,  and  espe- 
cially, while  doing  so,  attacking  ''messieurs  the 
gymnasts"  (Dr.  Kleen)  as  overanxious  to  secure  all 
possible  recogiiition,  are  rather  ill-chosen,  and  prove 
that  those  authors  do  not  know  gymnastics  and  only 
a  part  of  massage,  viz.,  that  small  part  which  can 
produce  a  cure  without  any  exercises. 

(1) 


2  ■  PRACTICAL   MASSAGk. 

A  first-class  masseur  noAvadays  must  necessarily 
know  gymnastics,  and  a  medical  gymnast  surely 
knows  massage.  ' 

In  these  lessons  then  we  will  consider  massage 
together  with  such  gymnastic  exercises  as  are  neces- 
sary in  order  to  do  the  most  good  for  the  patient. 

Let  us,  however,  be  frank  and  come  to  a  full 
understanding  of  what  we  are  trying  to  do. 

It  would  be  impossible  for  anyone  to  gain  a 
thorough  knowledge  of  this  system,  and  how,  under- 
standingly,  to  give  a  full  treatment,  from  a  few 
lessons  or  a  brief  manual. 

But  there  are  hundreds  of  cases  where  massage, 
together  with  a  few  possiz'c  and  resistive  movements, 
and  also  active  corrective  exercises,  will  not  only 
give  a  great  relief,  but  even  effect  a  cure,  wlien 
applied  judiciously  and  according  to  physiological 
laws. 

The  object  of  these  lessons  is  to  describe,  for  the 
use  of  the  doctor  himself,  or  for  an  operator  under 
the  doctor's  direction,  such  "movements"  as  may  be 
applied  in  the  sick-room  and  without  the  use  of 
apparatus,  and  also  to  outline  some  simple,  active, 
corrective  exercises  which  the  patient  may  be  taught 
to  practise. 

First,  let  us  look  a  little  into 


THI".   HISTORY. 


The  History 


of  this  curative  agent.  It  is  as  old  as  mankind. 
Nature  early  taught  the  man  to  knead  his  flesh,  or 
bend  his  body,  to  relieve  him  of  certain  ills.  And 
there  are  books  as  old  as  3000  years  B.C.  written 
alx)ut  g}annastics,  among  them  the  Kong-Fu  in 
Chinese.  We  also  know  that  the  Persians,  Phoeni- 
cians, and  Egyptians  knew  alx)ut  massage  as  well  as 
gymnastics. 

The  Greeks  were  the  first  to  make  a  genuine 
progress,  however,  in  this  branch,  as  in  so  many 
others. 

yEsculapius,  Apollo's  descendant,  is  said  to  have 
l)een  the  inventor  of  the  art  of  grymnastics.  Medea 
l>rocured  health  and  youth,  by  gymnastics. 

It  was  four  hundred  to  five  hundred  years  before 
Christ  that  Iccus,  and,  later,  Herodicus,  reduced 
bodily  exercises  to  a  system,  and  Herodicus  made  it 
a  branch  of  medical  science  to  preserve  the  health 
and  cure  diseases  by  use  of  gymnastics,  and  among 
his  pupils  was  the  famous  Hippocrates. 

Diodes,  Praxagoras,  Herophilus,  Asclepiades, 
Atheuceus,  Celsus,  and  Galen  recommended  "move- 
ment treatment,"  and  gave  rules  for  it. 

Mercurialis  in  the  sixteenth  century  wrote  a 
book,  "De  Arte  Gymnastica,"  or  the  science  of  bodily 
exercise,  which  he  divided  into  "G\minastics  for 
Athletes,  for  the  IMilitary,  and  for  the  Cure  of  Dis- 


4  PRACTICAL   MASSAGE. 

eases,"  to  which,  as  used  by  the  Greeks  and  Romans, 
he  gave  especial  attention,  and  pointed  out  the  use 
of  the  different  movements  in  different  diseases,  and 
also  gave  rules  for  their  application  in  special  cases. 

Many  a  poor  woman  v/as  burned  at  the  stake 
in  northern  Europe  during  the  Middle  Ages  because 
she  knew  a  little  more  than  other  persons  and  cured 
suffering  men  by  massage,  a  magic  which  was  looked 
upon  as  a  power  of  Satan. 

It  is  interesting  to  read  about  Thomas  Sydenham, 
1624-1689,  a  noted  English  physician,  called  "the 
English  Hippocrates,"  who  left  the  routine  practice 
and  based  his  own  upon  the  theory  that  there  is  in 
nature  a  recuperative  power  wdiich  ought  to  be  aided 
and  not  opposed ;  also  saying  that,  "if  anyone  knew 
of  the  virtues  of  friction  and  exercise,  and  could 
keep  this  knowledge  secret,  he  might  easily  make  a 
fortune."  There  are  many  of  these  persons  at  the 
present  day  in  the  United  States  claiming  mysterious 
and  magical  powers  of  curing  diseases,  setting  bones, 
etc.,  by  the  application  of  their  hands. 

Thomas  Fuller,  another  English  physician,  pub- 
lished in  1704  "Medicina  Gymnastica,"  treating  of 
the  power  of  exercise  in  preserving  health  and  cur- 
ing  disease. 

F.  Hoffman,  who  was  physician  to  the  King  of 
Prussia  in  the  first  part  of  the  eighteenth  century, 
wrote  that  exercise  is  the  best  medicine  for  the  body, 
and  that  we  cannot  imagine  how  salutary  and  favor- 
able to  health   it   is.   "for  it   excites  the   flow  of  the 


SWEDISH    MOVEMENT    TREATMENT.  5 

spirits,  and  facilitates  tlic  excretions  iruiu  ftlie 
blood." 

Clement  J.  Tissot,  a  iMxnch  physician,  who 
several  times  gained  the  prize  of  the  Academie 
Royale  de  Chiriirgie  for  his  lectures,  Dublished  in 
Paris,  1781,  "Gymnastic  IMedecinale." 

Gutsmuth,  Jahn,  Clias,  and  Spiess  worked  with 
energy  to  spread  the  German  gymnastics,  but  paid 
no  attention  to  gymnastics  as  used  for  the  treatment 
of  diseases. 

As  Herodicus  observed  the  curative  effects  of 
gvmnastics  on  his  own  delicate  health,  and  thereby 
was  brought  to  use  movements  in  therapy,  so  did  the 
Swede,  Pehr  Henrik  Ling,  in  the  beginning  of  the 
nineteenth  century,  study  the  movement  treatment, 
Ijccause  he  had  cured  himself  of  rheumatism  in  the 
arm  by  percussions. 

Ling  formerly  had  been  a)  fencing-master  and 
instructor  of  gymnastics;  but  afterward,  studying 
anatomy  and  physiology,  and  the  influence  of  the 
movement  and  manipulations  in  different  chronic 
diseases,  he  founded  a  system  of  gymnastics  cor- 
responding with  the  knowledge  of  physiology,  which 
is  universally  known  as  "the  Ling  System,"  or  the 

"Swedish  ^Movement  Treatment," 

By  ardent  study  and  labor.  Ling  succeeded  at 
last  in  making  his  new  ideas  recognized,  and  in  18 13 
the  first  college  for  pedagogical,  military,  and  medi- 


6  PRACTICAL   MASSAGE. 

cal  gymnastics,  called  the  ''Royal  Gymnastic  Central 
Institute,"  was  established  in  Stockholm  at  the  ex- 
pense and  under  the  supervision  of  the  Swedish  gov- 
ernment, and  Ling  was  its  first  president. 

The  principal  studies  for  graduation  are :  Anat- 
omy, Physiology,  Pathology,  Chemistry,  Hygiene, 
Diagnosis,  Principles  of  the  Movement  Treatment, 
and  the  use  of  exercises  for  general  and  local  de- 
velopment. 

In  the  rooms  of  this  institute  persons  of  every 
condition  and  age,  the  healthy  as  well  as  the  sick, 
the  wealthy  as  well  as  the  poor,  executed  prescribed 
movements.  The  number  of  those  who  adopted  the 
use  of  the  therapeutic  movements  increased  every 
year,  and  among  them  were  even  physicians  who  in 
the  beginning  had  been  the  most  opposed  to  Ling. 

Ling  died  in  1839.  His  pupils,  Brandting, 
Geoi'gii,  Liedback,  and  G.  Indebeton,  published 
Ling's  theories,  and  by  this  means  and  through  the 
many  foreigners  who  studied  at  the  Central  Institute 
of  Stockholm,  Ling's  system  soon  became  known  in 
a  great  part  of  the  world. 

Dr.  Joseph  Schreiber,  of  Vienna  (in  his  "Man- 
ual of  Massage  and  Muscular  Exercise"),  says: 
''The  most  powerful  impetus,  however,  given  to  the 
revival  of  mechanotherapy  originated  with  a  Swede, 
the  creator  of  the  modern  'movement  cure,'  whose 
doctrines,  spreading  to  England  and  Germany,  have, 
after  many  decades,  and  in  spite  of  l^eing  marked  by 
some  extravagances,   gained  universal   recognition." 


SWEDISH  M()vi-:mi-:.\t  tkkatmext.  7 

De  Ron,  in  St.  Petersburg;  Georgii,  Indclxjton, 
Bishop,  and  Roth,  in  London;  Rothstein  and  Neu- 
nian,  in  Berhn;  Richter,  in  Dresden;  Schreber,  in 
Leipzig;  Melicher,  in  Vienna;  Eulenburg,  in  Baden; 
Laisne  at  the  "Hopital  dcs  Enfants  Malades,"  in 
Paris;  Taylor,  in  New  York,  and  many  others, 
estabHshed  special  institutions  for  movement  treat- 
ment and  published  their  results,  partly  in  medical 
papers,  partly  in  books. 

Dr.  Douglas  Graham,  of  Boston,  has  written 
several  articles,  and  also  one  "Practical  Treatise  on 
Massage,"  in  which  he  says:  "Li  1844  the  Supreme 
Medical  Board  of  Russia  appointed  twO'  members  of 
the  Medical  Council  to  inquire  into  the  merits  of 
the  movement  and  manipulation  treatment  as  prac- 
tised by  M.  de  Ron,  one  of  Ling's  disciples  at  St. 
Petersburg,  who  had  been  using  it  then  for  a  period 
of  twelve  years.  From  the  highly  commendatory 
report  of  the  councillors  we  quote  the  following: 
*A11  passive  movements,  or  those  which  are  executed 
by  an  external  agent  upon  the  patient,  as  well  as 
active  ones  produced  by  the  effort  of  the  voluntary 
muscles,  and  the  different  positions  with  the  aid  of 
the  apparatus  or  without  it,  are  practised  according 
to  a  strictly  defined  method,  and  conducted  ration- 
ally, since  they  are  based  upon  mechanical  as  well 
as  anatomical  principles.  Experience  teaches  us  the 
usefulness  of  the  institution,  as  many  patients  thus 
treated    have    recovered    their    health    after    having 


8  PRACTICAL    MASSAGE. 

suffered  from  diseases  which  could  not  be  cured  by 
other  remedies.'  " 

It  was  not,  however,  until  after  the  middle  of 
the  nineteenth  century  that  massage  became  really 
known  and  was  considered  by  the  medical  profes- 
sion as  a  scientific  and  valuable  remedy  in  the 
treatment  of  diseases. 

Dr.  Mezger,  of  Amsterdam,  who  was  a  famous 
masseur  in  the  early  sixties,  was  the  man  who  under- 
stood how  to  win  the  confidence  of  the  public,  and 
later,  through  his  many  pupils,  exercised  a  powerful 
influence  upon  the  standing  of  massage  in  the  medi- 
cal world.  The  best  known  German  and  Austrian 
physicians,  as  Langenbeck,  Billroth,  Esmarch,  von 
Mosengeil,  GussinlMuer,  and  many  others  began  to 
employ  it  and  scientifically  publish  its  effects.  And 
soon  the  conviction  gained  gTound  that  massage  was 
a  powerful  curative  agent  which  had  been  neglected 
by  the  profession,  and,  therefore,  had  been  abused 
and  overestimated  by  ignorant  people.  All  o\'er 
northern  Europe  massage  was  known  and  constantly 
used,  and  Prof.  W.  S.  Playfair,  of  King's  College, 
London,  wrote,  in  1883,  "The  Systematic  Treatment 
O'f  Nerve  Prostration  and  Hysteria,"  which  greatly 
encouraged  the  more  general  use  of  massage. 

In  the  United  States  massage  was  hardly  known 
when  I  arrived  here  in  the  early  eighties.  The  late 
Dr.  Lewis  A.  Sayre,  of  New  York,  prescribed  it 
frequently,  and  I  had  several  cases  from  him  during 
my  short  stay  in  that  city.      Dr.   Weir  Mitchell,    in 


SWEDISH   MUVhMK.XT  AXU  MASSAGK  IX   U.  S.      9 

Philadelphia,  prescribed  "g^eneral  massai^e"  to  his 
jxitients,  and  he  wrote,  in  i<S77,  "l""at  and  IMood  and 
How  to  ]\Iake  Them/'  in  which  he  advocates  mas- 
sage. But  as  a  general  rule  the  medical  profession 
here  did  not  know  massage  and  were  not  willing  to 
try  it.  A  good  illustration  of  their  feeling  toward  it 
is  shown  in  the  answer  I  received  from  one  of  the 
oldest  and  best  known  physicians  in  \\'ashington, 
D.  C,  in  March,  1883,  when  asking  for  co-opera- 
tion :  "No,  sir ;  it  would  be  the  straight  w'ay  to  get 
the  patients  out  of  our  hands." 

Nevertheless,  massage  had  come  to  stay.  1 
opened  an  institute,  "The  Swedish  Health  Institute 
for  the  Treatment  of  Chronic  Diseases  by  Swedish 
Movements  and  jMassage,"  in  \\'ashington,  where 
the  foreign  diplomats  assembled  for  treatment  well 
known  to  them,  and  they  soon  brought  scores  of  the 
great  men  and  women  of  the  United  States  to  the 
institute,  and  gradually  the  physicians  of  the  city 
came  to  inquire  into  the  mode  of  treatment  and 
send  their  patients  there.  In  INIarch,  1888,  I  read  a 
paper  before  the  Clinical  Society  of  ]\Iaryland,  on 
"Sw^edish  INIovement  and  Massage  Treatment," 
which  appeared  in  several  medical  journals,  result- 
ing in  numerous  letters  from  medical  men  who 
wanted  to  know  more  about  it,  and  urging  me  to 
write  a  manual  and  also  give  instructions  on  the 
subject,  and  in  1889  my  Ixvok,  "Swedish  Movement 
and  Massage  Treatment,"  was  published.  In  the 
mean  time  massage  had  been  introduced  by  reliable 


10  PRACTICAL   MASSAGE. 

men  in  many  other  cities,  as,  Dr.  H.  V.  Barclay,  in 
New  York,  in  the  autumn  of  1884;  Baron  Nils 
Posse,  in  Boston,  1885,  where,  as  before  said,  Dr. 
Douglas  Graham  already  had  published  a  treatise 
on  massage,  and  the  medical  profession  soon  adopted 
this  mode  of  treatment  as  an  excellent  curative 
agent.  Still,  it  was  rather  amusing  sometimes  to 
notice  the  fumbling  of  otherwise  highly  recognized 
professional  men.  It  has  happened  more  than  once 
to  the  author  of  this  book  that  he  has  been  called 
in  by  physicians  to  apply  massage  to  patients  who 
were  already  suffering  with  a  high  fever,  and  he 
invariably  declined  to  do  sO'.  In  one  of  these  cases 
the  patient  died  the  following  day.  Had  the  physi- 
cian's request  been  acceded  to,  the  massage  treat- 
ment would,  no  doubt,  have  been  accredited  with 
hastening,  or  even  causing",  the  sick  man's  death. 

At  other  times  the  writer  has  asked  the  physician 
in  charge  what  the  illness  was,  and  has  been  told 
that  it  was  "none  of  his  business." 

A  Word  to  the  Physician. 

Some  physicians  sccui  to  liavc  iJie  idea  tJiat  we 
specialists  are  their  riz'als  and  their  opponents.  Still 
we  have  frequently  repeated  that  ice  do  not  practise 
medicine. 

We  are  specialists,  and,  as  such,  necessarily 
physiologists^     and     haz'e     the     practical     experience 


WORD    TO    Tin:    IMINSICIAX.  11 

gaiiird  by  /lie  fracticc  of  iiiaiiy  years  in  this  one 
branch. 

But  it  is  co-operation  bctii'coi  the  medical  pro- 
fession and  the  massage  specialists  which  is  desirable 
ami  necessary  in  order  to  produce  the  best  results. 

Therefore,  it  is  the  aim  of  this  book  to  enhghten 
those  who  want  to  know,  and  to  show  how  the 
treatment  shoukl  be  applied  in  chfferent  cases. 

Massage  is  based  on  pkiin  physiok3gical  laws, 
and  has  nothing  in  common  witli  ''magnetism,"  nor 
is  it  "regular  gymnastics,"  nor  "rubbing." 

\Mien  the  physician  desires  to  have  this  treat- 
ment applied  to  a  patient,  and  does  not  want  to 
execute  it  himself,  he  should  always  take  care  that 
the  one  employed  thoroug'hly  understands  his 
business. 

Much  harm  haS  been  done  both  to  patients  and 
to  the  reputation  of  "massag'e,"  because  physicians 
have  been  too  quick  to  accept  the  card  of  a  "mas- 
seuse" or  "masseiu^"  and  send  them  cases  without 
looking"  up  their  records.  I  know  of  several  in- 
stances where  good-looking  women  and  easy  talkers 
have  obtained  work,  although  they  did  not  know  the 
first  principles  of  massage,  while  others,  wdio  were 
first-class  masseuses,  but  did  not  look  so  well  and 
could  not  talk  so  well  as  their  sisters,  did  not  receive 
any  patients.  As  a  natural  result  of  this,  in  many 
cases  the  treatment  proved  of  no  value  whatever, 
and  in  some  instances  actual  harm  was  done. 


12  PRACTICAL   MASSAGE. 

As  Dr.  D.  Graham  says :  "It  is  not  to  be 
wondered  at  that  many  a  shrewd,  superannuated 
auntie,  and  others  who  are  out  of  a  job,  having" 
learned  the  meaning  of  the  word  massage,  imme- 
diately have  it  printed  on  their  card  and  continue 
their  'rubbin,'  just  as  they  have  always  done." 

Finally,  it  must  be  said  that  it  is  not  our  claim 
to  cure. all  kinds  of  diseases  by  massage.  Far  from 
that.  Some  diseases,  it  is  true,  can  be  cured  quicker 
by  this  method  than  by  any  other.  In  most  cases, 
however,  it  has  to  be  used  together  with  medical 
treatment,  for  the  same  reason  that  electricity,  baths, 
etc.,  are  very  often  employed  to  bring  about  a  cure. 
In  other  cases  it  should  be  resorted  to  only  as  an 
after-cure,  or  as  a  means  of  exercise. 

The  Variety  of  Movements  and  Duration 

of  treatment  is  of  great  importance. 

It  is  an  utterly  false  idea  that  "massage"  is 
merely  "rubbing,"  and  needs  only  to  be  applied  by  a 
strong  hand  and  for  an  hour's  time. 

As  Dr.  Graham-  says :  "The  argument,  too  often 
used,  that  massage  can  do  no  harm,  if  it  does  no 
good,  is  a  dangerous  one.  When  a  man  understands 
one  branch  of  the  medical  profession  well,  one  of 
the  commonest  errors  is  to  suppose  that  he  under- 
stands all  the  rest  equally  well,  as  if  our  knowledge 
of  massage,  like  everything  else,  did  not  come 
through  experience." 


VARIETY   OF   MOVEMENTS   AXD   DURATION".    13 

For  instance,  in  a  case  of  synovitis  or  glandular 
enlargement  or  sprains,  etc.,  the  manipulations 
should  always  be  directed  cciitripctoUy — toward  the 
heart ;  but  in  case  of  insomnia,  or  very  painful 
neuralgia,  the  manipulation  should  be  directed  down- 
Avard,  from  the  shoulder  toward  the  fingers,  from 
the  hips  toward  the  toes,  in  order  to  ease  and  quiet 
the  nerves.  In  cases  of  congestion,  movements  must 
be  applied  to  drive  the  blo<:>d  from  the  part ;  in  other 
cases,  as  anemia,  it  is  necessary  to  increase  the  flow 
of  blood  to  the  parts. 

Now%  for  instance,  there  are  two  patients,  a 
delicate,  small  woman  and  a  strong,  big  man,  Ixjth 
sufYering  with  the  same  kind  of  illness.  It  might 
be  fair  to  treat  the  man  for  about  an  hour,  but  it 
would  surely  be  too  much  to  let  the  woman  undergo 
the  same  treatment  for  the  same  length  of  time. 
Ahvays  bear  in  mind  that  the  old  maxim,  "If  a 
little  does  good,  more  will  do  more  good,"  is  an 
exploded   thec^ry. 

A  good  masseur  can  accomplish  more  in  fifteen 
minutes  than  a  poor  one  in  an  hour. 

"General"  massage  should  nczrr  hurt,  and  if 
black  and  blue  spots  appear  after  the  treatment,  it  is 
a  sure  sign  that  the  operator  did  not  know  his  busi- 
ness, although  we  often  hear  people  talk  al)out  the 
excellent  and  strong  masseuse,  who  makes  them 
"black   and  blue   all  over." 

"Local"  massage,  however,  often  has  to  hurt, 
and  if  the  patient  is  strong  and,  can  stand  it,  the  cure 


14  PRACTICAL   MASSAGE. 

will  many  times  be  hastened  considerably  by  a  strong 
and  vigorous  treatment.  But  great  care  and  tact 
must  be  used  by  the  operator  in  cases  of  weak  and 
delicate  oatients. 


How  Often  the  Treatment  Should 
BE  Repeated 

is  next  to  be  considered,  as  the  mistake  is  frequently 
made  by  physicians  to  recomjinend  their  patients  to 
try  massage  treatment  only  two  or  three  times  a 
week,  "because  they  cannot  stand  it,"  or  "they  are 
too  weak  to  try  it  oftener." 

The  weaker  a  patient  is  the  oftener  he  ought  to 
have  the  treatment.  It  should  be  applied  at  least 
once  a  day,  and  sometimes  twice,  in  order  to  derive 
the  most  l3€nefit  from  it.  The  effect  which  is  derived 
from  one  treatment  should  not  be  lost  before  the 
next  treatment  is  applied. 

It  is  the  treatment  which  builds  up  the  patient's 
strength,  but  if  only  tried  once  in  a  while  he  will 
feel  tired  and  stiff  a  day  or  two  afterward,  and 
naturally  conclude  that  the  treatment  does  him  harm 
— just  as  a  man  who  takes  a  ten-mile  horseback  ride 
once  a  week  feels  sore  and  stiff  each  time,  and  never 
gets  over  it  until  he  repeats  the  riding-  several  times 
weekly. 

To  a  weak  patient  the  treatment  has  to  be  given 
very  gently   in   the    beginning,    and,    providing    it    is 


PHYSlOUXilCAL    I'l'l'KCTS    Ol-    MOVEMENTS.     15 

applied  reg'ularly,  may  soon  1k>  increased  in  force, 
and  thus  more  vigor  is  given  to  the  patient. 

IIow  TO  BE  Dressed 

when  under  treatment  is  a  frequent  question.  In  all 
cases  where  the  manipulations  ^re  to  be  directed 
ccntripctally,  it  is  necessary  to  strip  the  body;  but  in 
other  cases  it  is  preferred  that  it  should  be  clothed, 
as  that  will  lessen  the  pain  which  sometimes  is  pro- 
duced by  the  manipulations,  and  the  skin  (not  being 
the  seat  of  the  trouble)  will  te  more  protected. 

The  dress  should  be  as  light  as  possible,  and  all 
tight  clothing  dispensed  with. 

Physiological  Effects  of  Movements. 

These  may  be  divided  into  two  groups : — 
First. — Purely  mechanical  effects  to  secure  the 
removal  of  lymph,  exudations,  extravasations,  etc., 
softening  of  exudations,  and  loosening  of  adhesions. 
Second. — Increased  circulation  by  stimulating  the 
muscular  and  nervous  systems,  causing  molecular 
changes,  changes  in  sensation,  and  changes  in  the 
nutritive  functions. 

By  Passive  Movements 

the  following  results  are  obtained : — 

I.  Extravasations      occurring     about      dislocated 
joints  are,  by  pressing  and  kneading  the  tendons  and 


16  PRACTICAL   MASSAGE. 

ligaments  in  which  they  are  imbedded,  finally  lique- 
fied, and  thus  more  quickly  absorbed. 

2.  In  stiffness  of  joints  the  contracted  muscles 
and  tendons  are  forcibly  but  generally  elongated,  and 
any  existing  exudations  or  vegetations  within  the 
joints  are  disintegrated  and  absorbed. 

3.  By  the  forcible  stretching  of  the  muscles  their 
nen^es  are  likewise  stretched,  molecular  changes 
being  thus  set  up  in  both. 

4.  Forced  extension  of  the  muscles  causes  pres- 
sure on  their  blood  and  lymphatic  vessels,  thus 
accelerating  the   circulation. 

5.  Finally,  such  muscles  as  have  by  rheumatic  or 
neuralgic  pains  been  kept  in  a  state  of  inactivity 
have  some  of  this  much-needed  exercise  restored  to 
them.  Passive  movements  thus  form  in  certain  dis- 
eases, as  in  neuralgia  and  rheumatism,  the  introduc- 
tion, as  it  were,  for  the  more  painful  active  motions 
which  have  to  follow. 

The  Active  and  Resistive  Movements 

cause  an  increased  flow  of  blood  to  the  muscles  and 
soft  parts,  increasing  thereby  the  circulation  and  re- 
moving accumulation  of  tissue  waste.  They  cause 
resorption  of  exudations,  transudations,  and  infiltra- 
tions, and  a  separation  of  adhesions  in  tendon- 
sheaths  and  in  joints.  They  increase  the  oxidizing 
powers  of  the  blood ;  they  relieve  the  congestion  of 


PHYSIOLOGICAL   EFFECTS    OF   MOVEMENTS.     17 

the  brain,  lungs,  intestine^s,  uterus,  liver,  and  kidneys, 
by  increasing-  the  flow  of  blood  to  the  muscles;  they 
stimulate  directly  the  sympathetic  ner^-oiis  system, 
thus  increasing  secretion,  and  reflexly  the  activity  of 
unstriped  muscle-fiber,  and  so  relieve  various  func- 
tional derangements. 

And  they  educate  morbidly  affected  muscles  to 
convert  abnormal  into  normal  actions  and  to  sup- 
press useless  movements. 

Thus  movement,  or  massage  treatment,  influences 
the  living  organism  : — 

First,  by  increasing  the  circulation,  respiration, 
and  temperature,  improving  the  digestion,  absorp- 
tion, and  nutrition,  and  facilitating  excretion. 

Second,  the  muscles  become  developed,  the  bones 
and  the  whole  human  frame  better  proportioned. 

Third,  appetite  is  increased,  and  the  food  is  taken 
with  greater  relish. 

Fourth,  sleep  is  facilitated. 

Fifth,  the  brain  acts  more  vigorously  and  is  freed 
from  psychical  depression. 

Sixth,  relieves  pain  and  removes  congestion. 

The  Movements  May  be  Spoken  of  as 

"Strengthening"  movements,  such  as  flexion,  ex- 
tension, torsion,  etc. 

"Stimulating"  movements,  as  percussion,  vibra- 
tion, etc. 

2 


18  PRACTICAL   MASSAGE. 

"Quieting"   movements,   as  rotation,   friction,   etc. 

"Derivative"  movements,  with  special  move- 
ments of  the  extremities. 

"Purgative"  movements,  as  kneading,  pressing, 
ajid  active  movements  of  the  abdominal  muscles. 

Some  movements  have  a  special  effect  on  the 
"respiration,"  others  on  the  "circulation,"  etc. 


CHAPTER  IT. 

The  next  thing  to  be  considered  is  the  classifica- 
tion of  movements  and  their  execution  and  effects. 
First,  let  ns  distinguish  between 

"Active"  axd  "Passive"  Movemexts. 

Active  movements,  l^eing  such  as  the  subject  per- 
forms entirely  by  voluntary  muscular  contraction, 
without  the  aid  of  the  masseur,  belong  to  the  regu- 
lar g)nnnastic  exercises,  although  some  of  them, 
the  "corrective"  exercises,  are  used  in  medical 
gymnastics. 

Passive  movements  are  such  as  the  patient  takes 
no  part  in  beyond  allowing  the  operator  to  move  the 
whole  or  any  portion  of  his  body — as  Hexion,  exten- 
sion, and  rotation — and  to  manipulate  it,  as  in  strok- 
ing, k)ieadi)ig,  percussing,  etc. ;  these  latter  are  more 
strictly  what  is  meant  by  "massage." 

But  what  is  mostly  used  in  medical  gymnastics 
are  the 

Resistive,  or  Duplicate  ^Movements, 

viz.,  "concentric  duplex"  movements,  such  as  the  pa- 
tient makes  while  the  operator  resists.  The  patient 
is  contracting  his  muscles  to  the   suitable   resistance 

(19)    • 


20  PRACTICAL   MASSAGE. 

of  the  operator,  and  consequently  the  muscles  in 
activity  are  shortened. 

This  is  the  more  frequently  used  form  of  resist- 
ive movement,  although  the  "excentric  duplex" 
movements,  such  as  the  operator  makes  while  the 
patient  resists,  are  very  useful  in  certain  cases.  The 
patient's  already  contracted  muscles  are  gradually 
extended  by  the  operator  and  consequently  elon- 
gated. This  form'  of  resistive  movements  should  be 
used  either  in  cases  where  the  muscles  are  abnor- 
mally contracted  or  where  they  are  too  weak  to 
contract  against  resistance,  but  still  have  strength 
enough  to  resist  excentrically.  An  illustration  of 
the  last  named  is  frequently  seen  in  the  gymnasium, 
when  the  child  is  unable  to  pull  himself  up  with  his 
amis  and  "chin  the  bar,"  while  he  may  jump  up  to 
it,  hang  in  his  bent  arms  and  gradually  extend  them, 
and  thereby  slowly  develop  his  muscles  to  the  desired 
strength.  Sometimes,  as  for  instance  in  cases  of 
paralysis  or  locomotor  ataxia,  it  becomes  ,  necessary 
to  help  the  patient  to  do  an  exercise  so  as  to  train 
the  motor  nerve  to  obey  the  patient's  will  and  thereby 
gradually  gain  strength  and  confidence  to  move  the 
muscles.     These  are  assistiz'c  vwi'cments. 

The  Positions 

in  which  the  movements  are  taken  are  numerous  and 
also  of  very  great  importance,  as  the  same  move- 
ment often  may  have  an  entirely  different  effect  in 
one  position'  from  that  in  another. 


THE    POSITIONS.  21 

There  are  six  fuiulanienlal  positions,  viz. : — 

Standing. 
Kneeling. 
Sitting. 
Reclining. 
Lying. 
Hanging. 
These    are    subdivided    into    a    number    of    starting 
positions  with  the  arms,  legs,  trunk,  and  head,  as: — 
Standing — hands  on  hips, 
arms  horizontal, 
arms  vertical,  etc. 
Sitting — astride  sitting, 

forward  bent  sitting,  etc. 
Lying — reclining, 
knees  bent, 
on  back  lying, 
on  front  lying,  etc. 
Which,  combined   in   various  ways,   make   thousands 
of  positions  in  which  the  different  movements  may  be 
either  taken  or  given.     And  so  the  number  of  move- 
ments may  be  said  to  be  endless,  to  suit  each  par- 
ticular ailment. 

\\'hatever  the  position  is,  care  should  be  taken 
that  nothing  interferes  with  the  patient's  breathing, 
as  he  should  nez'cr  hold  his  breath,  but  always  breathe 
easily  and  as  quietly  as  possible;  therefore,  the  head 
must  not  be  allow'ed  to  "fall  down  on  the  chest," 
but  be  kept  well  up. 


22 


PRACTICAL   MASSAGE. 


Passive  Movements. 
Manipulations  of  the  Arms. 

I.  Centripetal  stroking,  kneading,  and  cir- 
cular FRICTION  are  all  to  be  given  from  the  tips  of 
the  fing-ers  toward  the  shoulder. 

In  stroking,  grasp  the  patient's  finger  with  your 
thumb  and  two  first  fingers,  and  make  a  finn  pressing 


Fig.  1. — Centripetal  Stroking. 

and  stroking  movement  upward  toward  the  hand ;  at 
the  same  time  let  your  fingers  glide  in  a  circular 
way  round  the  patient's  finger,  describing  the 
motions  of  a  screw.  Let  your  fingers  glide  easily 
back  to  the  starting  point  (the  tip  of  the  patient's 
finger),  and  repeat  the  motions  fifteen  to  twenty 
times  in  about  ten  seconds  on  each  finger. 

In  treating  the  hand,   use  your  fingers   and   the 
palm    and   stroke   first    with    your   right    hand,    then 


MANIPULATIONS    Ol-    TIIIC    ARMS. 


23 


with  your  left  on  Ixjth  the  hack  and  pahn  of  the 
patient's  hand. 

Grasp  around  the  ami  with  your  riglit  hand  and 
make  a  firm  stroking-  in  the  screw  motion  from  the 
wrist  to  the  ellxnv,  ghding  easily  down  again  and 
rei^ieat  about  eight  times  in  ten  seconds,  then  use 
your  left  hand  in  the  same  manner.     (Fig.  i.) 

Kncadiugs  are  of  two  kinds,  viz.,  muscular  and 
circular. 


Fig.  2. — Muscle  Kneading  of  Fingers. 


In  muscle  kneading  of  the  fingers  make  an 
alternate  pressure  with  the  thumb  and  index  finger 
of  both  hands,  beginning  at  the  tip  of  the  pa- 
tient's finger,  about  twenty  pressures  in  ten  seconds. 
(Fig.  2.) 

Then  knead  the  muscles  of  the  hands  and  fore- 
arm toward  the  elbow  by  picking  up  each  group  of 
muscles  with  the  one  hand  (Fig.  3,  x4),  and  when 
releasing  the  grasp  make  an  upward  pressure  with 
the  other  hand  (Fig.  3,  5).  About  fifteen  kneadings 
in  ten  seconds. 


24 


PRACTICAL   MASSAGE. 


In  circular  kneading  grasp  the  patient's  finger 
with  your  thumb  and  two  first  fingers  and  let  each 
of  your  fingers  make   a  circular,   or  rotary,   motion 


Fig.  3. — Muscle  Kneading. 


while  pressing  so  hard  that  the  patient's  skin  is 
moved  and  not  your  fingers  rubbed  over  the  skin; 
gradually  push  your  fingers  upward  to  the  hand. 


MANIPULATIONS    OF    THE    ARMS. 


25 


Now  put  your  tlirce  middle  fino^crs  on  the  back 
of  the  patient's  hand  and  let  them  tog^ether  make  a 
circular  motion  hard  enough  to  move  the  underlying 
tissues  and  gradually  pushing  upward  (Fig.  4), 
alx)ut  twenty-five  circular  motions  in  ten  seconds. 
Then  the  same  manipulation  of  the  palnii  of  the 
hand.  Around  the  wrist  use  both  your  thumbs  in 
the  same  motions  and  knead  well  around  and  in  the 


Fig.  4. — Circular  Kneading. 


joint.  Again  use  your  three  fingers  or  the  whole 
hand  in  the  circular  motion  up  the  forearm  and  the 
elbow. 

In  circular  friction  grasp  the  hand  with  both  of 
yours,  and  make  upward  pushing  movements  alter- 
nately with  right  and  left,  constantly  moving  the 
hands  and  fingers,  and  especially  the  thumbs,  in  a 
semicircular    direction,    letting    the    one    hand    push 


26  PRACTICAL   MASSAGE. 

upward  while  the  other  ghdes  easily  down,  thereby 
making  a  sideways  friction  together  with  the  upward 
stroke  (Fig.  5),  twenty-five  motions  in  ten  seconds. 
Now  repeat  the  same  manipulations  from  the 
elbow  to  the  shoulders,  and  when  the  whole  arm 
has  been  worked  OA'cr  in  this  manner  make  firm 
strokes   from   the   fingers   to   the   shoulders,    clasping 


•..,, • -^ 

Fig.  5. — Circular  Friction. 


the  limb  around  with  both  your  hands,  from  five  to 
ten  times. 

The  Effects  of  These  Manipulations 

are  as  follows : — 

Any  pressure  on  the  muscles  must  necessarily 
exert  pressure  upon  the  underlying  veins  and  drive 
their  contents  away,  and  on  account  of  the  valves 
which  open  toward  the  heart  only,  it  is  clear  that  the 


EFFECTS    OF    MANIPULATIONS.  27 

contents  of  these  vessels  must  be  driven  toward  the 
center,  or  the  heart.  Therefore,  it  would  make  no 
difference  if  a  pressure  was  begiin  at  the  shoulder 
and  gradually  worked  down  the  arm — the  circula- 
tion of  the  blood  would  be  accelerated  either  w'ay; 
but  a  continual  stroking-  against  the  veins  would 
interfere  very  much  with  the  venous  circulation,  and 
even  produce  ruptures  of  the  vessels. 

Centripetal  stroking  quickens  the  circulation  in 
the  blood-  and  lymph-  vessels  and  even  sucks  the 
blood  from  the  vessels  below,  so  that  the  arterial 
stream  is  quickened  through  the  faster  outflow  from 
the  veins  and  the  diminution  of  the  venous  blood- 
pressure.  The  strokings  going  in  opposite  direction 
of  the  arteries  do  not  interfere  with  the  arterial 
stream,  because  the  position  of  the  arteries  is  deeper 
and  more  protected,  and  their  walls  are  much  more 
resistant.  Centripetal  stroking  brings  alx)ut  the  re- 
sorption and  disappearance  of  all  sorts  of  effusions, 
prevents  stasis  as  well  as  adhesions  of  the  white 
corpuscles  to  the  walls  of  the  vessels,  and  their  sub- 
sequent migration,  and  reduces  inflammatory  ten- 
sion and  the  pain  due  to  pressure.  Strokings  also 
heighten  the  nutrition  of  the  tissues,  and  are  a 
valuable  procedure  in  many  cases  of  traumatic 
injur}%  as  w'ell  as  in  some  cases  of  delayed  healing 
from  other  causes;  they  \\\\\  also  limit  or  prevent 
a  threatened  mortification  or  gangrene  in  certain 
cases.  And,  finally,  it  has  the  property  of  removing 
fatigue,  acting  as  a  restorative  to  groups  of  tired 
muscles. 


28  PRACTICAL   MASSAGE. 

Fatigue  results  from  the  presence  of  carbonic 
acid,  lactic  acid,  acid  phosphates,  etc.,  due  to  the 
consumption  of  oxygen  and  the  lack  of  those  sub- 
stances that  are  oxidized  during  muscular  contrac- 
tions ;  and  the  removal  of  these  products,  and  the 
access  of  fresh  blood,  rich  in  oxygen  and  oxidizable 
substances,  act  as  a  restorative  on  the  working 
power  of  the  muscles.  Experiments  have  been  made 
flexing  the  arm  at  the  elbow-joint,  while  raising  a 
weight,  till  exhausted ;  then  centripetal  stroking  has 
been  made  for  five  minutes,  immediately  after  which 
the  arm  was  able  to  perform  even  more  labor  than 
before. 

Muscle  kjicadiug  and  circular  kneading  are  both 
used  to  crush  newly  formed  vessels  and  half-organ- 
ized products  of  inflammation ;  to  stimulate  the  cir- 
culation and  further  the  resorption,  and  to  separate 
the  exudations  and  infiltrations  and  force  them  out 
in  the  lymph.  The  muscle  kneading  in  lifting  the 
muscles  up  and  again  pressing  them  against  the 
bones  acts  mainly  on  the  deeper  tissues  and  also 
helps  to  bring  about  contractions  of  the  muscles, 
and  is  therefore  especially  valuable  in  reducing 
fatty  degenerations  and.  make  stronger  muscles; 
while  the  circular  kneading  is  more  useful  to  sepa- 
rate foreign  bodies  and  tO'  licjuefy  extravasations 
and  promote  absorption. 

Circular  friction  has  a  similar  effect  as  the  strok- 
ing, but  by  moving  the  hands  in  a  semicircular 
direction  we  can  easier  reach  all  the  capillaries  and 
small  lymph-vessels. 


EFFECTS   OF   MANIPULATION'S.  29 

Generally  speaking:  Centripetal  stroking  quick- 
ens circulation  and  reduces  inilammations ;  muscle 
kneading  crushes  settled  and  waste  matters  in  the 
deei)er  tissues,  while  circular  kneading  does  the  same 
to  the  tissues  nearer  the  surface,  thus  separating 
foreign  material  into  small  atoms,  which  again  are 
sent  forth  through  the  veins  by  the  circular  friction 
and  the  last  strokings. 

Further,  muscle  kneading,  rather  quickly  and 
moderately  hard,  should  be  used  on  weak  and 
atrophied  muscles  to  make  them  contract  and  grow 
stronger;  while  circular  kneading  will  loosen  up 
tense  and  hardened  muscles. 

For  instance,  suppose  the  flexor  muscles  of  the 
arm  are  contracted  from  some  injury,  circular  knead- 
ing and  centripetal  stroking  under  full  extension  of 
the  arm  should  be  applied  on  the  flexors,  while 
muscle  kneading  and  "percussion"  should  be  used  on 
the  extensors,  and  also  some  resistive  movements 
to  strengthen  the  extensor  muscles  so  as  to  make 
them  able  to  overcome  the  contraction  of  the  flexors. 


CHAPTER  III. 

2.  Nerve  Compression. — Grasping  the  limb 
with  both  hands,  a  firm  pressure  is  made  around 
and  down  the  whole  ami  from,  the  shoulder  to  the 
fingers.      Repeated   three   to   five   times.      (Fig.    6.) 


Fig.  6. — Nerve  Compression. 

Both  hands  grasp  simultaneously  near  the  shoulder, 
and  the  pressure  should  be  evenly  distributed  by  the 
palm  of  the  hand  and  all  the  fingers  without  pinch- 
ing; when  the  grasp  is  released,  the  hands  move  a 
trifle  lower  and  around  the  arm  and  make  another 
pressure,  and  so'  on  tO'  the  fingers — five  to  six  pres- 
sures in  teit  seconds.  A  slow  and  even  pressure  is 
most  soothing  to  nervous  patients. 

This   increases   the  circulation   of   the  blood    and 
has  a  very  quieting  and  soothing  effect  on  the  nerves. 
(30) 


MANIPULATIONS   OF   THE   ARMS.  31 

In    extreme    nervous    cases    it    is    therefore    a    most 
valuable  manipulation. 

3.  Muscle  Rolling. — Grasping  the  limb  with 
the  palms  of  both  hands  (Fig.  7),  and  making  a 
(|uick,  alternate  pushing  and  pulling  motion,  and 
gradually  gliding  downward  from  the  shoulder,  the 
muscles  of  the  arm  will  be  rolled  and  squeezed 
asfainst   each   other,    whereby   the   circulation    of    the 


Fig.  7. — Muscle  Rolling. 

blood  is  very  much  increased.  Repeated  three  to 
five  times.  There  are  hardly  any  manipulations 
which  will  warm  the  arm  and  hand  as  quickly  as 
this. 

4,  Slapping. — This  is  performed  with  the  palms 
of  both  hands,  with  a  light  motion  of  the  wrist- 
joint,  and  the  whole  arm  is  slapped  from  the  shoulder 
downward  from  three  to  five  times.  This  stimulates 
the  action  of  the  nerves  and  the  circulation. 

5.  Friction   is  performed   with  the  fingers   and 


32  PFLA.CTIC/VL   MASSAGE. 

palm  of  the  hand  from  the  shoulder  and  downward, 
grasping  lightly  around  the  limb  with  both  hands — 
repeated  ten  to  thirty  times.  This  should  be  done  in 
slow  time  and  very  lightly  sO'  as  not  to  interfere 
with  the  venous  circulation.  Three  to  five  frictions 
in  ten  seconds. 

This  has  a  quieting  effect  on  the  nerves,  and  is 
often  sufficient  to  produce  sleep  in  nervous  and 
sleepless  patients. 

Nerve  compression,  muscle  rolling,  slapping,  and 
friction  are  frequently  used  together  as  an  excellent 
way  to  increase  the  circulation  of  the  blood  and 
quiet   the  nerv^es. 

As  before  said,  any  pressure  of  the  muscles  must 
necessarily  send  the  venous  blood  in  a  quicker  cur- 
rent toward  the  heart,  and  as  soon  as  the  pressure 
is  relieved  the  underlying  blood-vessels  suck  the 
blood  from  veins  and  capillaries  below,  which  again, 
by  the  diminished  blood-pressure,  increases  the  flow 
of  arterial  blood  toward  the  parts;  and  it  is  a  fact 
that  the  manipulations  working  in  a  downward 
direction  have  a  much  more  soothing  and  quieting 
effect  on  the  nervous  system.  Therefore,  in  certain 
nervous  affections  this  mode  of  applying  massage 
should  be  preferred  to  the  centripetal,  and  in  other 
cases  follow  it.  In  extreme  nervous  cases  "nen^e 
compression"  and  long,  light  "friction,"  downward 
are  most  beneficial. 

6.  Combination  Kneading. — Grasping  the  ami 
near  the  shoulder  with  both  hands  and  a  firm  pres- 


MAXirULATIOXS    OF    THE    ARMS.  33 

sure,  move  each  hand  outward  and  upward  hkc  a 
combined,  imtscle-rolliiig,  circular  kneading,  circular 
friction,  and  centripetal  stroking,  not  very  rapid,  so 
as  to  stretch  and  knead  the  underhng  muscles,  and 
gently  move  the  hands  dowmvard  toward  the  wrist ; 
all  pressure,  however,  being  in  centripetal  (upward) 
direction.  This  procedure  is  very  valuable  to  begin 
the  massage  of  an  ami  or  leg  before  the  other 
centripetal  strokings  and  kncadings  are  applied. 


Fig.  8. — Percussion. 

7.  Percussion  is  performed  with  the  edge  of  the 
extended  fingers  (Fig.  8),  which  are  kept  loose,  and 
with  a  quick  motion  of  the  wrist-joint  the  fingers 
are  flung  alternately  across  the  muscles.  The  quicker 
the  better. 

8.  Beating  is  performed  with  the  clenched  fist 
(Fig.  g,  A)  on  and.  around  the  fleshy  part- of  the  limb 
with  a  loose  and  light  movement  of  the  wrist-joint. 

3 


34  PRACTICAL   MASSAGE. 

(Fig.  9,  B.)     The  blow  must  be  firm  and  deep,  and 
one  a   second. 

These    two    motions    stand    foremost    among    the 
manipulations    which    aim    at    mechanical    excitation. 


Fig.  9. — Beating. 

A  blow  calls  forth  a  local  contraction  which  is  inde- 
pendent of  any  nervous  stim'ulus  by  reason  of  the 
independent  irritability  of  the  muscle  itself.  This  is 
a  particularly  effective  way  of  stimulating  a  muscle, 


MANIPULATIONS   OF   THE   ARMS 


35 


and  often  so  when  other  forms  of  stimuli  have  gi\cn 
out.  The  contraction  itself  furnishes  the  conditions 
for  a  quicker  access  of  blood  and  interchanj^e  of 
material,  increase  of  temperature,  and  nutritional 
activity. 


Fig.  10. — Arm  Vibration. 


Percussion  and  heating  are  very  important  parts 
of  massage,  and  are  extremely  serviceable  in  counter- 
acting muscular  atrophy  and  in  restoring  normal  size 
and  functional  power  to  groups  of  thin  and  weak 
muscles. 

These  manipulations  applied  gently  across  the 
muscles    cause    contraction    of    muscles    and    blood- 


36  PRACTICAL   MASSAGE. 

vessels;  while  applied  forcibly,  muscles  and  tendons 
will  loosen  and  thereby  overcome  contractons,  and 
cause  dilatation  of  the  blood-vessels. 

9.  Vibration. — The  operator  takes  hold  of  the 
patient's  hand  and  makes  a  slight  pull  and  a  very 
rapid  vibration  (shaking)  of  the  whole  arm.  Re- 
peated five  to  ten  times.  In  order  to  apply  this 
effectually  it  is  necessary  for  the  operator  to  make 
himself  as  rigid  and  tense  as  possible.     (Fig.  10.) 

This  has  a  stimulating  and  strengthening  effect 
on  the  nerves  and  also  on  the  respiration ;  and  it  can 
be  given  with  excellent  results  in  nervous  affections 
and  fatigue. 


CHAPTER    IV. 

Rotations  or  Circumduction  of  Arm, 
Hand,  and  Fingers. 

10.  Finger  Rotation. — The  joint  between  the 
finger  and  hand,  metacarpal  joint,  is  fixed  by  the 
operator's  one  hand,  and  with  the  other  the  finger  is 
rotated  (or  circumdncted)  in  its  joint;  at  the  same 
time  a  "piull"  is  appHed  to  the  fingers;  rotated  ten  to 
twenty  times  each  way,  and  abotit  twenty-five  rota- 
tions in  ten  seconds,  unless  the  finger-joint  is  very 
stiff.  In  such  case  the  joint  must  first  be  flexed 
(bent)  and  extended,  and  then  the  rotation  per- 
formed in  as  big  a  circle  as  the  joint  will  allow. 

11.  Hand  rotation  is  performed  by  taking  hold 
of  the  wTist  with  one  hand  and  of  the  fingers  wdth 
the  other  hand,  and  describing  a  circle  in  the  wrist- 
joint  from  ten  to  twenty  times  each  way — alx)ut 
twelve  rotations  in  ten  seconds,  with  a  piill  of  the 
hand. 

12.  Forearm  Rotation. — The  patient's  elbow 
is  fixed  in  the  operator's  one  hand,  who,  with  the 
other  hand,  takes  hold  of  the  patient's  w^rist  (Fig. 
it)  and  moves  the  foreami,  which  is  kept  on  an 
angle,  in  a  circle  in  the  elbow-joint,  from  ten  to 
twenty  times  each  w^ay — about  eight  times  in  ten 
seconds. 

(37) 


38  PRACTICAL   MASSAGE. 

13.  Arm  Rotation  (Single). — The  operator 
takes  hold  of  the  patient's  shoulder  with  one  hand 
and  of  his  elbow  with  the  other  hand,  moves  the 
arm  forward,  upward,  backward,  and  down  so  as  to 
describe  a  circle  of  the  shoulder-joint,   from  five  to 


Fig.  11. — Forearm  Rotation. 

ten  times  one  way  and  reverse  as  many  times — about 
five  times  in  ten  seconds,  with  a  pull  of  the  arm. 

The  arm,  forearm,  hand,  and  finger  rotations  are 
very  useful  in  stiffness  of  the  joints.  The  contracted 
muscles  and  tendons  are  forcibly  but  gradually 
elongated,  and  any  existing  exudations  within  the 
joints    are    disintegrated    and    absorbed.      But    these 


PASSIVE    MOVEMENTS    OE    THE    ARMS.  39 

movements  are  also  of  great  value  in  general  )iias- 
sagc  and  in  all  cases  where  it  is  desired  to  quicken 
circulation  or  to  draw  the  blood  away  from  the  chest 
and  head.  On  account  of  the  bent  position  of  the 
axillary  artery,  the  raising  of  the  arm  in  rotation 
stretching  it  out,  the  arterial  l)l()od-currcnt  is  very 
much  increased  at  the  same  time  that  the  pressure 
of  the  muscles  on  the  veins  drives  the  venous  blood 
to  the  heart,  and  a  very  rapid  flow  of  blood  to  the 
arm  and  hand  is  the  result.  The  movements  should 
always  begin  with  the  arm  and  end  with  the  fingers; 
and  if  done  well,  these  few  exercises  will,  as  a  rule, 
make  the  coldest  hand  warm. 

Arm  rotation  (single),  is  an  Excellent  movement 
in  cases  of  congestion  or  too  much  blood  in  the 
head. 

14.  "Flexion"  (passive)  of  onn,  hand,  and 
finger  is  also  a  ^•ery  valuable  and  necessary  move- 
ment to  break  up  adhesions  within  the  joints ;  and 
sometimes  great  force  must  be  applied  when  the 
shoulder-  or  elbow-  joints  are  stiff  from  dislocations, 
fractures,  etc. 

In  raising  the  ami  vertical  the  big  chest  and  back 
muscles — the  pectoralis  and  latissimus  dorsi — are 
being  stretched,  which  in  many  of  these  cases  is 
highly  necessary.  If  the  forearm  is  bent  the  exten- 
sors of  the  arm — especially  the  triceps — are  stretched ; 
and  when  the  arnn  is  extended  the  flexors — the  bi- 
ceps and  brachialis — are  stretched,  and  so  on.  These 
passive    stretchings    of    antagonistic    muscles    are    of 


40 


PR.\CTICAL   MASSAGE. 


great  importance  in  many  cases :  besides,  they  are 
also  beneficial  in  stretching  nerves  and  blood-vessels. 
15.  Vertical  Arm  Rotation  (Sitting). — The 
patient  sits  with  his  arms  extended  over  his  head ; 
the  operator  standing  behind,  supporting  the  patient's 


Fig.  12. — Vertical  Arm  Rotation. 


back  with  his  knee,  takes  hold  of  his  hands  (.Fig. 
12),  and  while  stretching  the  arms  well,  he  moves 
them  in  a  small  but  ^'ery  rapid  circle  fonvard,  out- 
ward, backward,  inward,  taking  care  not  to  strike 
the  anns  against  the  head.  This  is  not  reversed, 
but   repeated   three   to   six   times,    and   between   each 


PASSIVE    MOVEMENTS    OF   THE    ARMS. 


41 


quick  rotation  of  twenty  to  thirty  circlings  the  arms 
should  be  gently  lowered  a  little  in  front  and  pulled 
backward  while  a  pressure  is  made  with  the  knee  on 
the  patient's  back;  then  the  arms  are  again  raised 
and  the  quick  rotation  repeated. 


Forward  Arm  Rotation. 


This  makes  a  great  expansion  of  the  chest  and 
stretches  out  the  pectoral  muscles ;  the  blood  is 
drawn  out  of  the  arms,  and  the  apex  of  the  lungs  is 
brought  into  vibration ;  an  increase  of  pulmonary 
circulation  and  bronchial  absorption  follows;  the 
flow  of  the  blood  to  the  chest  causes  a  diminution  of 


42  PRACTICAL   MASSAGE. 

blood-pressure,  especially  in  abdominal  and  pelvic 
vessels. 

i6.  Forward  Arm  Rotation  (Sitting). — The 
operator,  standing  behind  the  patient,  the  latter  rest- 
ing his  back  against  the  operator's  chest,  then  takes 
hold  of  his  amis  just  below  the  elbows  and  moves 
them  in  a  circle  forward,  upward,  sideways,  and 
down,  but  not  reverse,  from  ten  to  twenty  times 
(Fig.  13) — about  twelve  to  fourteen  movements  in 
a  minute. 

This  expands  the  chest  and  has  a  great  effect  on 
the  respiration  and  the  circulation. 

17.  Shoulder  Rotation  and  Chest  Lifting 
(Sitting). — The  patient  sits  on  a  stool,  and  the 
operator,  standing  behind,  takes  hold  under  and  in 
front  of  the  patient's  shoulders,  moves  them  up- 
ward, backward,  and  down,  at  the  same  time  press- 
ing his  chest  against  the  patient's  back.  Repeated 
ten  to  twenty  times,  but  not  reversed.  (Fig.  14.) 
About  twelve  to  fourteen   times   in  a   minute. 

This  is  a  mild  but  effective  movement  in  weak- 
ness of  the  lungs  and  heart,  as  it  deepens  the  in- 
spiration followed  by  a  stronger  expiration,  thereby 
stimulating  the  flow  of  venous  blood  to  the  heart. 

Forward  arm  rotation  and  shoulder  rotation  are 
most  effective  respiratory  movements,  and  should 
be  given  frequently  to  patients  who  are  able  to  sit 
up,  so  as  to  increase  the  quantity  of  oxygen  and 
purify  the  blood,  which,  during  the  treatment,  is 
forced  to-  flow  rapidly.  But,  aside  from  this,  the 
deep    inspiration    draws    the    venous    blood    to    the 


PASSIVE    MOVEMENTS    OF    THE   ARMS. 


43 


heart,  and  is  therefore  of  great  vakie  in  diseases  of 
the  heart  i\s  well  as  in  cases  of  congestion  of  the 
brain  and  in  all  nervous  affections  which  produce 
flushHig  of  the  head  and  face.  In  lung  troul)les 
these  breathing  exercises  are  invaluable,  and  I  have 


Fig.  14. — Shoulder  Rotation  and  Chest  Lifting. 


often    with    a    single    application    brought    a    man's 
respiration  from  34  in  a  minute  down  to  20. 

Persons  who  have  been  diving  or  swimming 
under  water  frequently  compilain  of  headache  and 
their  eyes  are  bloodshot  from  congestion  as  a  result 
of  "holding  the  breath" ;  six  to  tw^elve  deep  breath- 
ings will  quickly  give  relief  to  those  cases. 


CHAPTER  V. 
Manipulations  of  the  Legs. 

i8.  Centripetal  stroking,  kneading,  and 
CIRCULAR  friction  shoulcl  all  be  applied  in  the  same 
manner  as  to  the  arms,  beginning  with  the  toes  and 
gradually  proceeding  toward  the  hip.  (Figs,  i,  2, 
3,  4,  and  5.) 

In  stroking  the  foot  use  your  right  hand  on  the 
patient's  right  sole  from  the  toes  toward  the  heel  a 
few  times,  and  also  up  along  the  instep;  use  the 
left  hand  on  the  front  and  outside  of  the  right  foot, 
and  both  hands  alternately  from  the  ankle  to  the 
knee. 

The  uiitsclc  kneading  of  the  foot  is  done  by  an 
alternate  squeezing  with  both  hands. 

The  rest  of  the  manipulations  are  the  same  as  to 
the   arnii, 

19.  Nerve  compression,  muscle  rolling,  slap- 
ping, and  friction  from  the  hip  toward  the  foot 
are  similar  to  those  movements  given  the  arms,  as 
described  in  Chapter  III.      (Figs.  6  and  7.) 

20.  The  combination  kneading,  as  applied  to 
the  arms. 

21.  Percussion,  as  applied  to  the  amis. 
(Fig.  8.) 

22.  Beating,  as  ai^plied  to  the  arms.     (Fig.  9.) 
(44) 


PASSIVE    MOVEMENTS    Ol-    THE   LEGS.  45 

23.  Vibration. — The  operator,  taking  hold  of 
the  patient's  heel  and  ankle,  makes  a  slight  pulling 
and  very  rapid  shaking  movement  of  the  whole 
limb. 

This  has  a  stimulating  effect  on  the  nen-es. 

24.  Stretching  the  Sciatic  Nerve  and  the 
Hamstrings. — The  patient  reclines  on  a  bed  or 
chair,  etc. ;  the  operator  bends  the  patient's  knee  and 
raises  the  leg,  resting  the  patient's  heel  on  his 
(operator's)  shoulder.  Now  he  makes  a  strong 
pull  upward  on  the  toes  (flexing  the  foot)  and  at 
the  same  time  stretches  the  knee  by  pulling  on  the 
thigh,  just  above  the  knee,  with  the  other  hand. 

This  is  an  excellent  way  to  stretch  the  nerve  and 
very  valuable  in  sciatic  neuralgia.  The  higher  the 
patient  sits  up,  the  more  forcible  is  the  exercise. 

Rotations  or  Circumductions  of  Leg  and  Foot. 

25.  Foot  Rotation  (Single). — The  operator 
fixes  the  patient's  ankle  with  one  hand,  and,  taking 
hold  around  the  toes,  without  pinching,  moves  the 
foot  around  in  a  circle  ten  to  twenty  times  one  way, 
and  reverses.     About  fifteen  times  in  ten  seconds. 

This  is  useful  to  break  adhesions  in  stiff  ankle- 
joints,  to  limber  the  joints,  and  to  bring  the  blood 
into  a  better  circulation. 

26.  Foot  Rotation  (Double). — The  patient, 
in  a  lying  or  reclining  position,  rests  the  back  of 
his  heels   against  a  cushion.     The   operator,    sitting 


46  '    PRACTICAL   MASSAGE. 

in  front  of  the  patient,  takes  hold  of  his  toes 
(Fig.  15)  and  moves  both  the  feet  in  a  quick  circle 
— the  quicker  the  better — twenty  to  thirty  times  one 
way,  and  reverses.  The  legs  should  be  kept  straight 
but  passive  during  the  motion,  so  as  to  allow  a 
vigorous  shaking  of  the  whole  limb. 

This  has  a  very  good  effect  on  the  circulation, 
and,  by  increasing  the  flow  of  blood  to  the  feet,  acts 
as  a  good  derivative  from  other  parts. 


Fig.  15. — Foot  Rotation  (Double). 

27.  Foot  and  toe  flexion,  passive,  whereby  the 
muscles  and  nerves  are  put  on  a  full  stretch,  are 
very  useful  movements.  Especially  in  paralysis  or 
other  cases  when  some  set  of  muscles  are  contracted 
— these  should  be  passively  stretched. 

28.  Thigh  Rotation  (Receining). — The  oper- 
ator takes  hold  of  the  patient's  foot — right  foot 
with  right  hand,  so  as  the  thumb  comes  on  the 
instep — and  of  his  bent  knee  with  the  other  hand 
(Fig.    16)  ;  the  knee   is   now   pressed   upward,    then 


PASSIVE    MOVEMRXTS    OF    THE   T.EGS. 


47 


moved  outward  and  downward  (without  Ix^ing 
straightened)  so  as  to  descril)C  a  circle  in  the  hip- 
joint;  the  knee  should  not  be  moved  to  pass  the 
middle  line  of  the  Ixuly,  and  the  movement  should 
be  firm  and  e\en,  with  a  good  pressure  of  the  knee 
upward.  The  pressure  is  done  at  the  foot,  while 
the  hand  at  the  knee  simply  steers  the  miotion.     The 


Fig.  16. — Thigh  Rotation. 


foot  must  be  kept  in  line  with  the  knee  and  not  be 
twisted  outward.  The  rotation  is  done  from  six  to 
fourteen  times  in  one  direction,  then  as  many  times 
reversed.     About  three  tO'  five  times  in  ten  seconds. 

This  is  one  of  the  best  exercises  for  equalizing 
the  circulation,  and  as  a  derivative  from  diseases  in 
the  pelvis  and  abdomen,  as  well  as  to  limber  the  hip- 
joint.      It   is   considered   a   delightful   movement   by 


48  PRACTICAL   MASSAGE. 

almost  every  patient,  and  may  be  used  frequently  in 
general  massage,  as  well  as  in  local  troubles. 

29.  Hip  Rotation  (Lying). — The  patient  lies 
flat  on  his  back  with  the  lower  extremities  outside 
the  bench  or  couch.  The  operator,  taking  hold  of 
the  ankles,  moves  both  legs  around  in  a  big  circle 
eight  to  twelve  times  in  one  direction,  then  as  many 
times  in  the  other. 

This  is  very  effective  in  affections  of  the  abdo- 
men and  pelvis. 

Passive  rotations  alternately  shorten  and  lengthen 
the  blood-vessels,  and  are  more  especially  effective 
with  the  bigger  veins.  When  they  are  stretched  they 
carry  more  blood  than  when  they  are  shortened,  and, 
therefore,  movements  which  alternately  shorten  and 
lengthen  these  vessels  act  as  a  sucking  power  on  the 
venous  circulation  toward  the  heart,  as  the  blood 
cannot  go  backward  on  account  of  the  valves. 


CHAPTER  VI. 

Passive  ^Movements  of  the  Trunk. 
(a)  Mcniipitlafions  of  tJic  Chest. 

30.  Chest  Friction  and  Chest  Kneading. — 
The  operator  puts  his  hands  on  the  patient's  chest 
with  the  finger-tips  pointing  at  the  throat  and  the 
thumbs  meeting  at  the  sternum,  then  makes  rapid 
strokings  with  l3oth  hands — one  to  each  side — and 
gradually  moving  his  hands  down,  always  begin* 
ning  at  the  middle  of  the  chest.  After  the  whole 
chest  has  been  treated  this  way  a  few  times,  the 
iintsclc  kneading  is  applied  by  picking  up  the  skin 
and  muscles  alternately  with  both  hands,  beginning 
at  the  sternum  and  following  the  pectoral  muscles 
out  to  the  side.  First  manipulate  one  side  of  the 
chest,  then  the  other. 

The  circular  kiicadi>ig  is  next  applied  with  one 
hand  on  each  side  of  the  sternum,  making  the  rotary 
motions  toward  the  side  of  the  trunk. 

31.  Chest  vibration  should  follow  the  knead- 
ings  by  putting  the  hands,  one  on  each  side  of  the 
chest,  and  pulling  downward,  making  a  rapid  vibra- 
tion, or  shaking,  with  very  tense  hands  and  fingers. 

The  friction — sidew^ays  stroking — should  finish 
these  manipulations. 

^  (49) 


50  PRACTICAL   MASSAGE. 

32.  Chest  Slapping  (Standing). — The  oper- 
ator, standing"  in  front  of  the  patient,  brings  his 
hands  on  the  back  of  the  patient's  shoulders  and 
slaps  him  over  the  region  of  the  lungs,  thus  mov- 
ing' forward  under  the  amis  tO'  the  chest  and  all 
over  the  chest  up  to  the  shoulders  in  front.  Re- 
peated three  to  six  times. 

If  the  patient  is  lying  down  the  slapping  is  done 
by  alternately  using  both  hands  rapidly  all  over 
chest  from  side  to  side  and  gradually  moving  the 
handsi  upward  to  the  shoulders. 

The  slapping  should  be  done  with  the  palm  and 
fing-ers  and  a  lig'ht  movement  of  the  wrist,  without 
keeping  the  hands  stiff. 

The  friction,  kneading,  vihrati  -.,  and  slapping 
of  the  chest  are  frecpiently  used  in  "general"  mas- 
sage as  a  fine  exercise  for  the  chest  muscles  and  to 
increase  the  circulation  and  tone  up  the  nervous 
system  of  the  whole  chest,  lungs,  and  heart.  They 
are  very  useful  in  weakness  and  emphysema  of  the 
lung's,  organic  diseases  of  the  heart,  and  in  nervous 
palpitation. 

33.  Chest  Lifting  and  Vibration  (Reclin- 
ing).— The  operator,  standing  in  front  of  the  pa- 
tient, puts  his  hands  on  each  side  and  under  the 
shoulders  of  the  patient,  then  lifts  him  slightly 
(Fig.  17),  and,  by  shaking  his  hands  while  he  pulls 
them  forward  under  the  patient's  arms,  eft'ects  a 
vibration  of  the  whole  trunk.  Repeated  four  to 
eight    times.      This    stimulates    the    lungs    and    heart 


MASSAGE   OF  THE   ABDOMEN. 


51 


and  is  a  very  good  rcspiratoiy  movement  for  a 
patient  who  cannot  sit  up.  1  liax'e  often  gi\-en  great 
relief  to  asthmaiic  patients  with  a  few  apphcations 
of  this  movement. 

(b)  Abdoiiiiual  Massage. 

34.  Stomach  friction  is  made  with  both  hands 
all   over  the  abdomen   from   the   middle   and   out   to 


Fig.  17. — Chest  Li  f tins:  and  Vibration 


the  sides,  beginning  under  the  ribs  and  gradually 
moving  downward ;  this  is  followed  with  an  upward 
stroke  with  the  one  hand  on  the  right  side,  beginning 
at  the  cecum  and  over  to  the  left  in  the  direction  of 
the  ascending  and  transverse  colon,  and  then  a  down- 
ward stroke  with  the  other  hand  on  the  left  side  in 
the  direction  of  the  descending  colon  to  the  sigmoid 
flexure.     Repeated  four  to  eight  times. 

This  influences  the  activity  of  the  intestines. 


52  PR.A.CTICAL    MASSAGE. 

35.  Muscle  Kneading  of  the  Abdomen. — 
\\'ith  both  hands  the  operator  ahernately  kneads  and 
rolls  the  flesh  and  muscles  of  the  abdomen  in  a  circle 
from  the  right  upward,  oxer  to  the  left  and  down- 
ward, in  the  direction  of  the  ascending,  transverse, 
and  descending  colon.  After  a  few  treatments  the 
operator  should  be  able  to  make  very  finn  and  deep 
kneadings  without  any  disagreeable  feeling  to  the 
patient ;  the  intestines  will  be  forced  to  greater  con- 


Fig.  18. — Muscle  Kneading  of  the  Abdomen. 

traction  and  activity,  and  fat  and  flabby  abdominal 
muscels  will  be  reduced  and  made  firmer.     (Fig.  18.) 

The  muscle  kneading  of  the  abdomen  is  espe- 
cially useful  in  constipation  and  obesity. 

36.  Knuckle  Kneading  of  the  Abdomen. — 
With  the  slightly  bent  knuckles  of  th©  fingers  an 
alternate  pressure  is  made  with  both  hands,  begin- 
ning at  the  middle  line  under  the  ribs,  and  grad- 
ually and  evenly  moving  the  hands  out  to  the  sides, 
taking  care  not  to  press  on  the  hip-bones ;  then  the 


MASSAGE   OF   THE   ABDOMEN.  53 

knuckles  are  again  placed  at  the  middle  line  a  little 
lower  than  fn'st  time,  and  so  on  till  the  whole  ahdo- 
men  has  been  kneaded  in  this  manner.      (  h ig.    19.) 

This  is  very  useful  in  constipation  and  to  make 
the   intestines  more  active. 

T^y.  Circular  Kneading  of  the  Abdomen. — 
The  operator  places  his  three  middle  fingers,  which 
are  held  close  together,  upon  the  spot  which  is  to  be 


Fig.  19. — Knuckle  Kneading  of  the  Abdomen. 

manipulated — either  in  the  gastric  region  or  on  the 
stomach,  or  beginning  at  the  cecum  and  following 
the  colon — and  pressing  lightly  (Fig.  20)  executes 
circular  kneading.  After  a  thorough  kneading  on 
one  spot  the  fingers  are  lifted  and  placed  on  another 
spot  nearby  and  so  on. 

In  case  of  constipation  begin  at  the  sigmoid 
flexure,  kneading  thoroughly,  then  lift  the  fingers 
and  move  a  little  higher  up  the  descending  colon, 
again    kneading    well,    and    move    higher    up,    then 


54 


PRACTICAL   MASSAGE. 


across  the  transverse  colon  to  the  right  and  down 
the  ascending  colon  to  the  cecum,  always  making"  the 
pressure  of  the  kneading  in  line  of  the  normal 
passage.  This  will  help  to  loosen  up  hardened  matters. 
Then  knead  the  colon  from  cecum  to  sigmoid  flexure. 


Fig.  20. — Circular  Kneading  of  the  Abdomen. 


This  kind  of  kneading  is  probably  the  mO'St 
effectual  of  them  all  and  acts  very  powerfully  on  the 
glands  and  epithelium  of  the  alimentary  canal ;  it 
has  a  very  stimulating  effect  on  the  abdominal 
organs  and  their  nerves.     It  increases  the  activity  of 


MASSAGE    OF   THE   ABDOMEN. 


55 


the  stomach  and  the  secretion  of  the  juices,  and 
effects  a  l)etter  mixture  of  the  secreted  juices  and 
the  food  substances.  It  is  therefore  of  great  vahie 
in  cases  of  inchgcstion,  dysj^psia,  constipation,  etc. 

38.  Stomach  Vibration. — The  operator  presses 
his  shghtly  l>ent  fingers  under  the  patient's  ribs  on 
the   left   side   and    apphcs   a    rapid   vibration   on   the 


Loin  Vibration. 


ventricle;  the  hands  should  be  mo\ed  so  as  to  apply 
the  vibration  all  over  the  left  hypochondriac.  Re- 
]:)eated  three  to  six  times,  and  followed  by  stomach 
friction. 

Useful  in  dyspepsia  and  chronic  catarrh  of  the 
stomach  and  to  increase  the  appetite. 

39.  Bowel  Vibration  (Standing). — The  oper- 
ator, standing  behind  the  patient,  puts  both  hands  on 


56  ■  PRACTICAL   MASSAGE. 

the  patient's  abdomen,  and  by  a  rapid  pushing  and 
pulhng  motion  of  his  hands  an  effective  vibration  is 
applied  tO'  the  whole  bowel.  Repeated  three  to  six 
times ;  very  useful  in  constipation. 

40.  Bowel  Concussion  (Lying). — The  oper- 
ator's hands  are  placed  on  the  patient's  abdomen, 
and  a  pressure  is  made — deep-  but  evenly ;  then  the 
hands  are  cjuickly  taken  off,  allowing  the  abdomen 
to  spring  back  like  a  rubber  ball.  Repeated  three 
to  five  times. 

This  strengthens  the  abdominal  muscles  and  the 
digestive  powers. 

41.  Loin  Vibration  (Sitting). — The  operator, 
standing  behind  the  patient,  who  sits  on  a  stool 
slightly  stooping  forward,  presses  his  hand  with  the 
ulnar  edge  on  each  side  of  the  patient  just  above  his 
hips  (Fig.  21),  and  applies  a  very  rapid  alternate 
pushing  and  pulling  movement  with  his  hands.  The 
hands  must  be  firm  and  not  glide  on  the  flesh.  Re- 
peated three  to  six  times  at  short  intervals. 

This  has  a  very  stimulating  effect  on  the  liver 
and  stomach  and  on  the  lungs  and  the  diaphragm. 

42.  Loin  Traction  (Lying). — The  operator 
puts  his  hands  on  each  side  and  under  the  small  of 
the  back  of  the  patient,  and  pulls  his  hands  forcibly 
forward,  just  above  the  hips.  Repeated  four  to  ten 
times. 

This  has  a  very  soothing  effect  and  is  useful  as  a 
finish  to  abdominal  massaee. 


MASSAGE   OF   THE   ABDOMEN.  57 

Of  all  the  different  kinds  of  massage,  the  "ab- 
dominal" has  more  special  intluencc  on  blood-pres- 
stn'e,  which  is  increased  considerably  durino^,  and  for 
a  while  after,  these  manipulations.  Abdominal  mas- 
sag-e,  therefore,  should  not  be  used  in  cases  of  recent 
bleeding  within  the  brain,  in  the  lungs,  or  stomach. 


CHAPTER  VII. 
Massage  of  the  Back. 

43.  Back  Friction. — The  operator  puts  his 
hands  on  the  patient's  neck  with  the  finger-tips  point- 
ing upward  and  the  thumbs  meeting  at  the  spine, 
then  makes  rapid  strokings  simultaneously  with  both 
hands,  one  to  each  side,  gradually  moving  down- 
ward to  the  buttocks,  but  always  applying  the  strokes 
from  the  spinal  column  outward  and  never  toward 
the  spine,  neither  up  the  back.  Repeated  four  to 
ten  times. 

Has  a  soothing  and  quieting  effect. 

44.  Back  Muscle  Kneading.— The  operator 
first  manipulates  the  muscles  of  the  neck  and  shoul- 
ders and  gradually  proceeds  downward  to  the  but- 
tocks, picking  up  the  muscles  with  one  hand  and 
squeezing  with  the  other,  from  the  spinal  column 
outward,  following  the  course  of  the  trapezius  and 
latissimus  muscles,  first  on  one  side  of  the  back,  then 
on  the  other.  Repeated  three  to  six  times.  (Fig. 
22.)  Increases  circulation  and  the  action  of  the 
nerA'^esi  and  has  a  good  effect  on  tired  muscles. 

45.  Back  Muscle  Rolling. — The  operator,  put- 
ting both  his  hands  side  by  side  on  one  of  the  pa- 
tient's shoulders,  makes  an  alternate,  very  rapid 
pushing  and  pulling  motion  with  hisj  hands,  gradually 

(58) 


MASSAGE    OF   THE    BACK.  59 

moving'  downward  to  the  buttocks;  the  hands  must 
be  so  firmly  on  the  patient  as  to  move  his  muscles 
from  side  to  side,  thereby  causing-  a  quick  stretching 
and  a  vibration  of  them.  First  roll  the  muscles  of 
one  side  of  tb.e  back  three  to  five  times,  then  the 
other  side. 

Increases  circulation. 

46.  Back  Circular  Kneading. — The  oper- 
ator's middle  three  fing-ers  of  each  hand  begin  at  the 


Fig.  22. — Back  Muscle  Kneading. 

neck  on  each  side  of  the  spine  and  apply  the  circular 
kneading  outward,  then  begin  a  little  lower  and 
work  outw^ard,  one  hand  on  each  side,  and  so  on  to 
the  end  of  the  spine,  thus  kneading  the  buttocks  and 
hips  thoroughly.     Repeated  three  to  six  times. 

Increases  resorption  and  has  a  very  soothing 
effect. 

47.  Back  ^^IBRATION. — The  operator  puts  both 
hands,  with  the  fingers  spread  out,  one  on  each  side 
of  the  patient's  back  up  at  the  shoulders,  then  pulls 
downward  ■with  a  firm  pressure  and  a  rapid  vibra- 


60 


PRACTICAL   MASSAGE. 


tion  of  hands  and  fingers.  Repeated  three  to  five 
times. 

Stimulates  the  nerves. 

48.  Spinal  Nerve  Compression. — The  operator 
presses   with   his  middle   and    index   fingers   on   each 


Fig.  23. — Back  Percussion. 


side  of  the  spinal  column  from  the  neck  to  the  end 
of  the  spine ;  the  pressure  should  be  made  a  little 
inward  and  upward,  fimily,  without  jerking,  in  a 
slow  and  quiet  way.     Repeated  two  to  four  times. 

Relieves  backache  and  is  very  soothing  and 
restful;  if  done  with  vibration  of  the  fingers  it  is 
stimulating-  to  nerve-centers. 


MASSAGE   OF   THE    BACK.  61 

49.  Back  percussion  is  applied  with  the  edge  of 
both  hands  and  fmg'ers  aUcrnatcly  and  very  (juickdy 
from  the  neck  downward  on  b<Jth  sides  of  the  spinal 
column.  On  the  upper  part  of  the  back,  from  the 
shoulders  to  the  lower  end  of  the  lungs,  the  per- 
cussion may  also  be  applied  outward  to  the  sides. 
Repeated  six  to  ten  times.      (Fig.  23.) 

This  has  a  very  stimulating  and  strengthening 
effect  on  the  nerve-centers. 

50.  Long  Friction  Down  the  Back. — Place 
lx)th  hands,  one  on  each  shoulder,  and  make  long, 
slow,  and  lig'ht  strokings  down  the  whole  back.  Re- 
peated ten  to  twenty  times. 

This  should  always  follow  and  finish  the  other 
manipulations  of  the  back,  as  it  has  an  exceedingly 
soothing  and  quieting  eft'ect. 

In  extreme  nervous  cases  this  friction  downward 
is  often  enough  to  put  the  patient  tO'  sleep. 

The  whole  process  of  back  massage — back  fric- 
tion, muscle  kneading,  muscle  rolling,  circular  knead- 
ing, znbrafion,  spinal  nerve  compression,  percussion, 
and  long  friction  donmicard — is  considered  the  most 
delightful  and  soothing  of  all  manipulations.  And 
it  is  well  worth  while  for  a  masseur,  or  masseuse,  to 
practise  this  to  perfection. 

Aft'ections  of  the  heart,  lungs,  and  stomach  are 
also  reached  and  relieved  through  l)ack  massage. 
Many  a  mother  has  been  able  to  quiet  and  put  to 
sleep  her  crying  baby  simply  by  patting  and  stroking 
its  back,   whereby  stomach-aches  have  been  relieved. 


62 


PRACTICAL   MASSAGE. 


51.  Breech  Beating  (Standing). — The  oper- 
ator puts  his  left  hand  on  the  patient's  abdomen  for 
support,  the  patient  standing  with  his  hands  on  a 
table  or  bed,  and  with  his  right,  moderately  clenched 
fist    he    applies    the    beating    over    the    sacral    bone 


Fig.  24. — Breech  Beating. 


from  hip  to  hip  and  down,  all  over  the  buttocks  to 
the  thighs.  The  beating  should  be  done  with  a 
light  wrist-movement,  but  firm,  deep,  and  slowly. 
(Fig.  24.) 

Then  put  the  right  hand  on  the  small  of  the  back 
and  apply  a  quick  vibration  by  making  your  arm 
very  tense. 


MASSAGE   OF   THE   BACK.  63 

If  tlie  patient  is  in  bed  a  pillow  shoiikl  be  put 
under  the  abdomen,  and  spinal  vibration,  with  the 
right  hand  placed  against  the  end  of  the  spine  may 
be  applied  by  shaking  the  hand  very  rapidly. 

This  acts  on  the  sacral  ner\-es  and  on  the  pelvic 
organs,  and  draws  the  blood  to  the  surface  muscles ; 
it  is  useful  in  weakness  and  congestions  of  the  blad- 
der and  sexual  organs,  and  also  in  constipation  and 
hemorrhoids,  etc. 


CHAPTER  VIII. 
Head,  Face,  and  Throat  Massage. 

When  a  boy  of  about  14  years  I  suffered  a  great 
deal  from  headache  over  the  forehead  and  temples, 
and  as  Dr.  Winge,  of  Christiania,  Norway,  had  just 
returned  from  his  study  with  Dr.  Mezger,  I  went 
to  him  for  massage,  and  after  one  month's  daily 
treatment  I  was  completely  cured.  This  treatment 
lasted  only  five  minutes  each  day  and  consisted  of 
hard  percussion  all  over  the  forehead  with  a  small 
hammer  on  the  end  of  which  there  was  a  layer  of 
rubber;  after  a  couple  of  minutes  of  this  pounding 
my  head  was  rested  against  the  doctor's  chest  while 
he  nibbed  my  forehead  with  all  his  might  with  his 
rig'ht  hand,  using  some  lard  in  order  not  to  take  the 
skin  off  tog-ether  with  the  headache.  It  was  a  heroic 
treatment  and  did  not  "feel  g'ood,"  especially  when 
I  would  sit  down  in  the  chair  with  a  bursting  head- 
ache before  the  doctor  began.  But  a  few  minutes 
after  the  treatment  I  would  walk  away  "light- 
hearted"  and  "clear-headed."  And  I  am  still  in 
debt  to  this  doctor  for  many  reasons — he  chased  away 
my  headache,  and  ga\e  me  the  first  ideas  about 
Mezger  massage,  of  which  I  later  made  a  deeper 
study. 

The  Mezger  method  is  pretty  rough,  and  at  times 
(64) 


HEAD    MASSAGE.  65 

it  is  necessarily  so.  hut  in  iiKist  cases  it  is  not,  and  the 
masseur  will,  as  a  rule,  find  it  much  more  Ixineficial. 
both  to  himself  and  to  his  jxitients,  to  use  a  little 
longer  time  and  a  little  less  roughness.  Especially 
in  head,  face,  and  throat  massage  it  will  be  found  of 
great  value ;  so  that  the  patient  says :  "Ah !  that  is 
good — it  feels  so  nice!     It  rests  me  so!" 

52.  Head  Percussion  (Sitting). — The  operator, 
standing  in  front  of  the  patient,  first  makes  some 
friction  with  lx)th  his  thumbs  from  the  middle  of  the 
forehead  and  over  the  temples,  several  times.  Then 
percussion  is  applied  with  the  edges  and  tips  of  the 
fingers  of  both  hands  simultaneously,  beginning  at 
the  middle  of  the  forehead  and  going  straight  back- 
ward to  the  base  of  the  skull ;  now  begin  again  at  the 
forehead,  but  each  hand  a  little  farther  out  to  the 
temples,  next  still  nearer,  and  at  last  over  the  temples 
and  backward  down  the  neck — about  thirty  percus- 
sions in  ten  seconds. 

Then  a  rapid  percussion  is  given  alternately  with 
both  hands,  all  over  the  forehead  and  temples,  the 
crown  of  the  head,  and  the  neck — four  to  eight 
times. 

A  znbration  at  the  base  of  the  skull  is  often  applied 
after  the  percussion,  by  placing  one  hand  on  the 
patient's  forehead  for  supix>rt,  and  with  the  ulnar 
edge  of  the  other  hand  or  little  finger,  pressed  on  the 
neck  just  l^elow  the  base  of  the  skull,  make  a  very 
rapid  vibration — three  or  four  times  at  short  in- 
tervals. 


66  PRACTICAL   MASSAGE. 

53.  Kneading  of  the  Head  (Sitting). — The 
patient's  head  rests  against  the  operator's  chest,  he 
standing  behind.  Begin  at  the  comer  of  the  nose  and 
make  cirailar  kneading  with  the  index  and  middle 
fingers  of  'one  hand,  followed  with  stroking  of  the 
other  hand,  working  from  the  nose  around  the  eye- 
brows and  to  the  temple;  then  begin  a  little  higher 
over  the  nose  and  work  outward,  next  still  higher,  till 
the  line  of  the  hair  is  reached.  Now  work  the  other 
side  of  the  forehead  in  the  same  manner. 

Then  give  circular  kneading  with  both  hands,  one 
on  each  side  of  the  nose,  working  outward  to  each 
temple.  After  the  whole  of  the  forehead  has  been 
well  kneaded,  spread  all  the  fingers  on  the  scalp  and 
let  each  finger  make  a  small  circular  kneading,  taking 
care  not  to  glide  on  the  skin  or  pull  the  hair;  raise 
the  hands  and  remove  the  fingers  to  other  spots,  and 
so  on  until  all  of  the  scalp  has  been  well  treated. 

In  kneading  the  neck  support  the  head  with  one 
hand  and  knead — both  muscle  kneading  and  circular 
kneading — with  the  other  hand  from  the  skull  down 
the  neck  011  each  side  and  over  011  the  shoulders,  fol- 
lowed with  a  few  strokings  in  the  same  direction. 

54.  Head  Vibration. — After  the  kneading  place 
both  hands  around  the  patient's  head  and  make  a  firm, 
even  pressure  and  rapid  vibration,  or  trembling,  of  the 
hands. 

55.  Friction  of  the  forehead  and  temples  and 
back  over  the  neck  with  both  hands  should  finish  the 
head  massage. 


FACIAL   MASSAGE.  67 

These  manipulations  of  the  licad  are  exceedingly 
beneficial  in  cases  of  headache,  weariness,  insomnia, 
etc.,  and  always  have  a  soothing-  and  (juieting  effect  on 
nervous  patients. 

But  aside  from  these  general  effects  there  is  no 
doubt,  to  my  mind,  that  the  circular  kneading  of  the 
scalp  will  produce  new  growth  of  hair.  In  fact,  I  have 
seen  several  excellent  proofs  thereof.  One,  a  lady  of 
65  years,  who  had  worn  a  wig  for  more  than  twenty 
years;  she  began  after  my  advice  to  give  herself  scalp 
massage  twice  every  day  for  about  ten  or  fifteen  min- 
utes each  time,  and  when  I  saw  the  lady  again,  after  a 
couple  of  years,  she  had  a  good  crop  of  hair  all  over 
her  head.  The  simple  reason  is  that  the  massage  will 
bring  nourishment  to  the  roots  of  the  hair  and  thereby 
awaken  Nature  to  new  life. 

56.  Facial  Massage. — Soon  after  I  had  opened 
my  Institute  in  Washington,  in  1883,  two  ladies,  who 
had  seen  their  best  days  of  life,  called  and  asked  if 
massage  would  take  away  wrinkles  from  the  face.  At 
that  time  I  had  not  thought  of  this  and  had  never  seen 
any  account  of  such  treatment  from  other  masseurs,  so 
I  did  not  encourage  the  ladies  and  I  never  saw  them 
again.  But  the  incident  set  me  to  thinking,  and  I  do 
not  now  hesitate  to  say  that  massage  will  prove  itself 
to  1>e  the  best  agent  in  removing  wrinkles  and  in  mak- 
ing a  face  younger  and  more  beautiful  if  kept  up 
regularly  for  weeks  and  months  at  a  time.  This  cer- 
tainly is  reason  enough  for  the  many  offices  and  "par- 
lors" for  facial  and  scalp  massage,  or,  as  it  is  often 


68  PRACTICAL   MASSAGE. 

called,  the  "scientific"  manipulation,  which  signs  we 
now  see  everywhere  in  the  cities. 

However,  this  kind  of  massage  is  often  errone- 
ously explained  by  certain  waiters  of  "beauty  and 
health"  in  magazines  and  newspapers. 


Fig.  25. — Veins  of  Head  and  Neck. 

Let  us  take  a  look  at  Fig.  25,  which  shows  the 
veins  leading  from  the  head  and  face.  The  facial  vein 
(i)  coming  from  the  corner  of  the  eye  and  nose, 
crosses  obliquely  down  the  cheek,  taking  up  the  venous 
blood  from  other  parts  of  the  face  and  finally  emptying 


FACIAL   MASSAGE.  69 

its  contents  into  the  inlcnia!  jii'^uhir  I'cin  (2)  farther 
down  the  neck.  The  external  jiii^iilar  z'ciii  (3)  re- 
ceives the  venous  blood  from  the  head,  neck,  and  ears, 
and  carries  it  in  an  ahirost  straight  Hne  to  the  superior 
vena  cava. 

Now  v^^ith  this  fact  in  view  it  is  hard  to  understand 
how  persons  who  claim  to  know  can  advise  making 
strokings  upward  the  cheek  from  the  neck  and  chin. 
This  is  in  strict  opposition  to  all  laws  for  massage  and 
cannot  produce  any  good  effect.  The  strokings  and 
also  circular  kneading  with  the  tips  of  one  or  more 
fingers  should  follow  the  direction  of  the  veins  in  order 
to  accelerate  the  circulation  of  the  blood  and  to  produce 
quick  absorption  of  waste  material.  If  strokings  are 
directed  from  below  and  upward,  congestion  may  set 
in  and  impure  matters  may  be  more  firmly  imbedded 
in*  the  walls  of  the  blood-vessels  and  even  rupture  of 
small  vessels  may  occur. 

In  case  of  wrinkles  put  the  index  and  middle  finger 
of  one  hand  on  each  side  of  the  groove  and  stretch  it 
out,  while  circular  kneading  is  applied  with  one  finger 
of  the  other  hand  right  on  the  groove ;  this  process  to 
follow  the  course  of  the  wrinkle  in  the  same  direction 
as  the  veins. 

If  the  face  is  discolored,  or  there  are  pimples,  the 
circular  kneading  followed  with  strokings  on  the  big 
facial  and  jugular  veins  should  l^e  applied. 

If  the  face  is  too  fat  or  flabby,  muscle  kneading, 
or,  rather,  a  pinching,  picking  up  the  flesh  with  the 
thumb  and  index  and  middle  fingers,  and  letting  each 


70  PRACTICAL   MASSAGE. 

finger  squeeze  and  knead  thq  part  before  releasing"  the 
hold  and  removing  to  another  spot  near  by.  This 
process  may  as  well  be  given  from  the  chin  and  up  if 
that  seems  desirable,  as  there  is  no  stroking  to  be  done. 

If  the  face  is  poorly  nourished  apply  circular  knead- 
ing and  also  pressure  and  light  vibration  on  the  twigs 
of  the  fifth  cranial  nerv^es,  where  the  stars  are  shown 
on  Fig.  25. 

Always  keep  in  nnnd  that  the  circular  kneadi)ig, 
not  too  hard,  brings  nourishment  and  produces  health 
and  growth,  while  muscle  kneading  reduces  fatty  sul> 
stances. 

57.  Throat  massage  has  proved  itself  of  such 
^'alue  in  cases  of  sore  throat,  tonsillitis,  and  catarrh  of 
the  throat  and  nose,  and  against  rushing  of  blood  to 
the  head,  that  it  ought  to  be  a  common  remedy  in 
every  family.  If  mothers  would  apply  this  method  as 
soon  as  the  children  complain  of  any  soreness  or  pain 
in  the  throat  and  ears,  or  they  are  troubled  with 
catarrh,  much  suffering  would  be  spared  the  little  ones 
and  many  a  wakeful  night  and  big  doctor  and  drug- 
gist bills  l^e  spared  the  parents. 

In  applying  throat  massage,  stand  in  front  of  the 
patient,  who  sits  or  reclines,  with  his  head  well  back ; 
put  your  hands  with  the  palms  upon  the  side  of  the 
patient's  neck  so  as  to  let  the  edge  of  your  right  little 
finger  comei  just  under  the  left  ear,  and  the  edge  of 
your  left  little  finger  under  the  right  ear  of  the  patient; 
now  make  a  stroke  down  toward  the  chest  and  shoulder 
over  the  course  of  the  jugular  vein,  at  the  same  time 


THROAT    MASSAGE  71 

turning  your  hands  with  the  pahn  full  a,iL;ainst  the 
throat  and  neck,  and  continue  the  stroke  down  to  the 
chest.     Keep  this  up  for  five  to  ten  minutes. 

In  connection  with  the  stroking-  of  the  throat  it  is 
often  valuable  to  give  circular  kticadiii'^  in  the  same 
direction  and  vibration  of  flic  larynx  by  applying  the 
hand  on  the  patient's  larynx,  the  thumb  on  one  side 
and  the  fingers  on  the  other,  and,  without  squeezing, 
give  a  rapid  vibration,  trembling,  gradually  sliding  the 
fingers  forward.     Stimulation  of  the  nerves. 

58.  Head  Rotation  (Sitting). — The  operator 
places  his  one  hand  on  the  back  of  the  patient's  head, 
and  the  other  hand  on  his  forehead,  and  slowly  moves 
the  head  in  a  circle,  five  to  ten  tinres  one  way,  then  as 
many  times  the  other  way.  Four  to  five  times  in  ten 
seconds. 

This  acts  on  the  blood-vessels  and  nerves  ol  the 
neck  and  throat ;  it  is  a  derivative  movement  from  the 
brain,  and  has  a  quieting  effect. 

59.  Head  Flexion,  Passive  (Sitting). — In  cases 
of  stiff  neck  it  often  becomes  necessary  to  bend  the 
head  in  the  opposite  direction,  so  as  to  stretch  out  the 
contracted  muscles,  and  while  they  are  under  stretch 
centripetal  stroking  (from  head  down)  and  also  cir- 
cular kneading  should  be  applied. 


CHAPTER  IX. 

Resistive  Movements  of  the  Arms. 

60.  Finger  Flexion  and  Extension. — The  pa- 
tient's -hand  rests  either  on  the  operator's  knee  or  on 
the  edge  of  a  table,  while  he  bends  and  stretches  all 
the  fingers,  and  the  operator  makes  resistance. 

61.  Hand  flexion  and  extension  is  done  by  tak- 
ing hold  of  the  patient's  wrist  with  one  hand,  and  with 
the  other  hand  resist,  while  the  patient  is  bending  and 
stretching  the  wrist-joint. 

These  twO'  exercises  develop  and  strengthen  the 
muscles  of  the  forearm,  hand,  and  fingers,  and  increase 
the  flow  of  blood  to  them. 

62.  Arm  Flexion  and  Extension. — Position  as 
in  "forearm"  rotation.  (Fig.  11.)  The  patient  bends 
his  arm  in  the  elbow-joint  as  far  up  as  possible,  while 
the  operator  resists,  and  gradually  gives  way,  so  as  to 
make  the  flexor  muscles,  the  biceps,  contract  and  shorten 
to  their  utmost,  whereby  the  extensor  muscles,  with 
their  nerves  and  blood-vessels,  are  passively  extended. 
Then  the  patient  gradually  stretches  out  the  arm, 
under  resistance,  so  as  to  make  the  extensor  muscles, 
the  triceps,  contract  and  shorten,  and  thereby  pas- 
sively extend  the  flexor  muscles,  nerves,  and  vessels. 

These  exercises   are   "concentric-duplex"    and   de- 
velop and  strengthen  the  muscles  and  also  act  as  an 
excellent  l>lood-propeller  to  and  from'  the  heart. 
(72) 


RESISTIVE   MOVEMENTS    OF   THE   ARMS.        73 

If  the  muscles  are  rather  contracted  and  stiff,  the 
"excentric-duplex"  movements  should  be  given  in  the 
following  way:  Position  as  before,  beginning  with  the 
ami  bent  well  up;  the  operator  gradually  stretches  out 
the  armi,  while  the  jxitient  makes  resistance;  the  con- 
tracted flexor  muscles  are  slowly  elongated  and  ex- 


Fig.  26. — Vertical  Arm  Flexion  and  Extension. 

tended.  Then  the  operator  l>ends  the  arm,  while  the 
patient  resists,  and  the  contracted  extensor  muscles  are 
slowly  stretched  out. 

The  first  kind — "concentric"  movements — are  used 
alternately,  bending  and  stretching  for  general  exer- 
cise: while  the  second — "excentric"  movements — 
should  be  used  either  for  the  elongating  of  the  flexor 


74  PRACTICAL    MASSAGE. 

muscles  or  for  the  extensor  muscles,  whichever  of  them 
are  in  need  of  such  exercise. 

63.  Vertical  Arm  Flexion  and  Extension 
(Sitting). — The  operator  stands  behind  the  patient 
and  takes  hold  of  both  his  hands,  resisting  the  patient 
when  he  bends  the  arms  close  down  to  the  side  and 
stretches  his  arms  to  vertical  position,  "concentric- 
duplex,"  in  a  slow  movement  alongside  of  his  ears,  the 
elbows  being-  kept  well  out  to  the  side.  The  operator's 
knee  should  be  pressed  against  the  patient's  back  with 
a  small  pillow  between.  Repeated  from>  five  to  four- 
teen times.     (Fig.  26.) 

In  the  extension  of  the  arms,  the  triceps,  deltoid, 
supraspinatus,  trapezius,  and  serratus  magnus  are 
principally  at  work,  and  a  full  passive  extension  of  the 
pectorals  is  effected.  In  flexion  of  the  arms,  by  hold- 
Hig  the  arms  well  to  the  side  and  not  allowing  them  to 
be  pulled  forward,  the  latissimus  dorsi  and  teres  major 
are  the  chief  workers,  and  the  pectorals  are  kept  in 
a  semi-neutral  condition  sO'  as  not  to  contract  and  de- 
press the  chest.  The  rhomboids  and  levator  anguli 
scapuLne  draw  the  shoulders  backward ;  and  the  biceps 
and  brachialis  anticus  bend  the  forearm. 

These  exercises  then  are  very  valuable  to  strengthen 
the  miuscles,  straighten  the  back,  and  to  expand  and 
deepen  the  chest. 

64.  Horizontal  Arm  Flexion  and  Extension 
(Sitting). — The  patient's  arms  are  raised  horizon- 
tally and  kept  well  back,  with  the  forearms  sharply 
l>ent  upon  them ;  the  operator,  standing  behind,  press- 


RESISTIVE    MOVEMENTS    OF   THE    ARMS.        75 

\ug  liis  chest  against  the  ])riticnt's  hack,  takes  hold  of 
both  his  wrists  (Fig.  27)  and  resists,  wlicn  the  patient 
stretches  and  bends  his  arms  at  the  ellxjw-joints,  "con- 
centric-duplex." Repeated  from  five  to  fourteen  times. 
By  keeping  the  upper  amis  well  back  and  not  allow- 
ing them  to  be  moved  forward,  this  exercise  exerts  a 


Fig.  27. — Horizontal  Arm  Flexion  and  Extension. 


powerful  tension  on  the  chest  and  contraction  of  the 
muscles  of  the  shoulder-blades,  and  neck  (the  trape- 
zius, rhomboids,  and  levator  anguli  scapukne),  and  the 
arms.  It  is  therefore  an  excellent  exercise  to  flatten 
round  shoulders  and  round  out  flat  chests,  and  it  is  a 
good  respiratory  and  derivative  movement. 


76 


PRACTICAL   MASSAGE. 


65.  Horizontal  Arm  Separation  and  Closing 
(Sitting). — The  operator,  standing  in  front  of  the 
patient,  who  holds  his  arms  straight  out  tO'  the  sides, 
takes  hold  of  his  wrists  and  pulls  the  arms  forward 
under   resistance   by   the  patient,    "excentric-duplex." 


Fig.  28. — Horizontal  Arm  Separation  and  Closing. 


Then  the  patient  brings  his  arms  back  to  the  former 
position,  resisted  by  the  operator,  "concentric-duplex." 
Repeated  from  five  to  fourteen  times.     (Fig.  28.) 

This  is  another  form  of  strong  contractive  exercise 
for  the  muscles  of  the  back  and  shoulders,  while  it  is 
absolutely  passive  for  the  chest  muscles,  and  is  very 


RESISTIVE   MOVEMENTS   OF  THE   ARMS.       77 

useful  in  stooping  shoulders  and  many  cases  of  lung 
troubles,  as  it  has  a  goo<l  effect  on  the  respiration  and 
the  circulation.  As  a  rule  the  pectoral  muscles  of  pa- 
tients do  not  need  encouragement  for  contraction,  but 
once  in  a  while  it  may  be  necessary,  and  in  such  a  case 


Fig.  29. — Lateral  Arm  Elevation  and  Depression. 


the  alx)A-e  movement,  while  the  operator  resists  both 
forward  and  backward,  making  each  move  a  "concen- 
tric" exercise,  will  be  very  valuable. 

66.  Lateral  Arm  Elevation  and  Depression. — 
The  operator,  standing  behind  the  patient,  takes  hold 
of  his  forearms,  which  are  hanging  down,  and  resists 


78 


PR.\CTICAL   MASSAGE. 


when  the  patient  raises  his  arms  sideways,  upward, 
and  when  he  brings  them  down  again,  "concentric." 
The  elbows  should  be  kept  straight.  Repeated  five  to 
ten  times,     (Fig.  29.) 

This  is  a  very  effective  movement  to  widen  the  chest 
and  to  strengthen  the  muscles  of  the  shoulders,  back, 
and  upper  arms,  viz.,  the  deltoid,  supraspinatus,  rhom- 


Fig.  30. — Forward  Arm  Traction  (Lying). 


boids,  levator  anguli  scapul?e,  trapezius,  and  triceps  m 
upward  motion ;  and!  latissimus  dorsi,  pectorals,  teres 
major  and  minor,  and  subscapularis  going  downward. 
It  is  also  effective  on  the  respiration  and  circulation. 

67.  Forward  Arm  Traction  (Lying). — The  pa- 
tient lying  on  a  table  or  a  couch  with"  his  arms  ex- 
tended alongside  the  ears,  gradually  pulls  his  anns 
upward,  forward  and  downward,  while  the  operator 


RESISTIVE    MOVEMENTS    OF   THE    ARMS.         79 

makes  resistance,  ''concentric."  (Fig".  30.)  Now  the 
patient  resists  while  the  oi^^rator  pulls  the  arms  back- 
ward again,  "excentric."     Repeated  four  to  ten  times. 

This  is  a  very  powerful  movement  on  the  anterior 
muscles  of  the  trunk;  it  raises  the  chest  and  inills  all 
upward.  It  produces  a  suction  of  the  blood  from  the 
abdomen  and  pelvic  vessels  to  the  chest,  and  is  there- 
fore of  great  value  in  reducing-  congestions  in  those 
organs,  as  well  as  to  reduce  obesity. 

68.  Arm  Torsion. — The  patient  takes  hold  of  the 
middle  of  a  stick  with  one  hand  and  keeps  his  arm 
straight  out  from  the  shoulder.  The  operator  takes 
hold  of  each  end  of  the  stick  and  resists  the  patient 
when  he  izcists  his  ami  outward  and  inward,  "con- 
centric." This  movement  may  be  changed  by  letting 
the  patient  resist  when  the  operator  twists  the  arm, 
"excentric."     Repeated  front  six  to  ten  times. 

This  brings  into  play  the  rotators  of  the  arm,  viz., 
inward  rotation:  subscapularis,  pectoralis  major,  latis- 
simus,  teres  major,  and  anterior  deltoid ;  outward 
rotation :  infraspinatus,  teres  minor,  and  posterior  del- 
toid, and  is  used  in  stiffness  of  the  shoulder-joint  and 
in  abnormal  enervations  of  the  muscles  of  the  arm, 
and  as  a  derivative  from  the  chest  and  head. 


CHAPTER  X. 

Resistive  Leg  Movements. 

69.  Foot  Flexion  and  Extension:  (A)  Single 
AND  (B)  Double  (Fig.  15). — Positions  as  in  foot 
rotations.  The  patient  bends  and  stretches  his  feet 
during  resistance  by  the  operator,  "concentric." 


Fisr.  31. — Lesr  Flexion  and  Extension. 


These  strengthen  the  anterior  and  posterior  mus- 
cles of  the  leg  and  foot,  and  strengthen  and  limber  the 
ankle-joint.  It  is  a  good  derivative  movement,  and  is 
especially  beneficial  in  cases  of  cold  feet. 

70.  Leg  Flexion  and  Extension  (Reclining). 

— The  operator,  standing  by  the  side  of  the  patient, 

takes  hold  of  his  heel  with  one  hand  and  of  the  ball  of 

the  foot  with  the  other  hand.     (Fig.  31.)     The  leg  is 

(80) 


RESISTIVE    MOVEMENTS    OF   THE   LEGS. 


81 


bent  way  up  without  resistance,  and  tlien  the  patient 
stretches  it  out,  while  the  operator  resists  by  pressing 
the  leg-  upward  and  slightly  giving  way  till  it  is  per- 
fectly straight,  "concentric."  Repeated  five  to  four- 
teen times. 

The  first  part  O'f  this  movement  puts  the  extensor 
muscles  of  the  thigh,  viz.,  gluteus  maxinms,  gluteus 
niedius,  pyriformis,  obturator  internus,  gemellus,  etc., 


Fig.  32. — Upward  Knee  Traction. 


and  also  the  quadriceps  muscles  of  the  leg,  with  their 
nerves  and  blood-vessels,  on  a  perfect  stretch,  while 
the  second  part  makes  them  contract  vigo-rously,  and 
thereby  serves  as  an  excellent  movement  to  strengthen 
the  extensor  muscles  of  the  whole  hinbi  and  also  as  a 
derivative  from  diseases  of  the  pelvis  and  alxKimen. 

71.  Upward  Knee  Traction  (Reclining). — 
The  operator  takes  hold  oi  the  back  of  the  patient's 
heel  with  one  hand  and  on  the  front  of  his  foot  with 


82 


PRACTICAL   MASSAGE. 


the  other  hand  and  resists,  when  the  patient  bends  his 
leg — piiHing  his  knee  npward — 1)y  holding  it  straight, 
and  slightly  giving  way  till  it  is  doubled  up,  "eoiicen- 
tric;"  now  the  patient  resists  while  the  operator  pulls 
the  leg  straight  again,  "excentric."  Repeated  four  to 
ten  times.     (Fig.  32.) 


Fig.  33^ — Knee  Flexion  and  Extension. 


This  movement  strengthens  the  flexor  niuscles  of 
the  leg  and  the  museles  of  the  abdomen,  viz.,  psoas 
magnus,  iliacus,  sartorius,  gracilis,  gluteus  minimus, 
and  biceps,  and  thus  has  a  purgati\'e  effect. 

Leg  flexion  and  extension  and  np-K'ord  knee  traction 
are  often  used  alternately  as  a  good  "general"  exercise. 


RESISTIVE   MOVEMEXTS    OF   TTIE   LEGS.         83 

72.  Knek  Fi.exiOxNT  and  I'^xtkxsion  (Sitting). — 
The  operat(M%  sittint;-  l)y  the  side  oi  the  jjatienl,  who.se 
thigh  is  I'esting  on  the  operator's  knee  (  hig.  2)3)^  fixes 
the  patient's  knee  with,  one  hand  and  takes  hold  with 
the  other  hand  around  his  ankle,  resisting,  when  the 
patient  bends  and  stretches  his  knee,  "concentric."  Re- 
Ideated  five  to  ten  times. 

In  this  nio\'ement  all  the  flexor  and  extens(M-  mus- 
cles of  the  leg  are  in  vigorous  action,  wherehv  the  thigh 
and  the  knee  are  developed  and  streng-thened ;  it  is  also 
a  valuable  exercise  to  break  adhesions  and  overcome 
stiffness  of  the  knee-joint. 

The  exercise  is  still  better  when  the  patient  is  stand- 
ing and  rests  his  thigh — in  a  right  angle  with  the  body 
— oil  a  bar. 

/T,.  Leg  Elevation  and  Depression  (Lying). — 
The  patient,  keeping  his  knee  straight,  raises  his  leg 
upward  by  bending  the  hip-joint,  the  operator  making 
slight  resistance  with  his  hand  on  the  patient's  knee, 
"concentric."  Then  the  patient  resists,  while  the  op- 
erator presses  the  limb  down  again,  "excentric."  Re- 
peated two  to  ten  times.     (Fig.  34.) 

This  may  also  be  performed  with  both  legs  at  the 
sauTe  time  when  the  patient  is  yi^ung  and  strong;  but 
often  in  the  beginning,  it  is  all  the  patient  can  do  to 
raise  the  leg"  "actively" — without  resistance — and  let  it 
slowly  down ;  and  sometimes  it  will  be  found  enough 
to  simply  raise  the  bent  knees. 

The  muscles  of  the  abdomen,  the  flexor  muscles  of 
the  thigh,  and  the  extensor  muscles  of  the  leg  are  here- 


84 


PRACTICAL   MASSAGE. 


by  brought  into  play.  It  is  a  fine  exercise  in  cases  of 
constipation  and  obesity,  and  other  cases  where  the 
abdominal  muscles  need  to  be  strengthened. 

74.  Backward  Leg  Traction  (Standing). — 
The  patient,  standing  on  a  stool  and  holding  on  to  a 
bar  or  between  the  door,  pulls  one  leg  forward  as  far 
as  possible,  while  the  operator  resists,  "concentric" ; 
then  the  patient  resists  while  the  operator  pulls  the  leg 


Fig.  34. — Leg  Elevation  and  Depression. 


backward,  "excentric."  The  operator  resists  with  one 
hand  on  the  front  of  the  ankle,  and  gives  support  on 
the  patient's  hip  with  the  other  hand.     (Fig.  35.) 

This  is  another  and  very  useful  form  of  abdominal 
exercise  and  very  useful  in  constipation  and  obesity, 
and  to  draw  the  blood  from  the  pelvic  organs. 

y^.  Leg  Separation  and  Closing  (Lying). — 
The  operator  takes  hold  of  the  patient's  ankle  and  re- 
sists him  when  he  brings  his  leg  out  to  the  side,  "con- 


RESISTIVE    MOVEMENTS    OF   THE    LEGS. 


85 


centric."  Then  the  patient  resists  while  the  operator 
presses  the  les^  into  its  former  position,  "excentric." 
Repeated  four  to  ten  times. 

This  may  also  1j€  perfomied  with  both  leg's  at  the 
same  time,  when  the  oi>erator  stands  in  front  of  the 


:^ 


Fig.  35. — Backward  Leg  Traction   (Standing). 


patient  and  takes  hold  of  both  his  ankles,  resisting, 
while  the  patient  separates  his  legs,  and  ag^ain  pulls 
them  together  under  resistance  of  the  patient. 

The  abductors  of  the  legs,  viz.,  the  glutei  muscles, 
tensor  .vagin?e  femoris,  pyrifonnis,  gemelli,  sartorius, 
obturator   internus,    are   hereby    strongly    contracted. 


86 


PR.\CTICAL   MASSAGE. 


while  the  adductors  are  kept  passive ;  and  the  exercise 
becomes  a  strong  one  for  the  hips  and  thighs  and 
tends  to  reduce  big  hips  as  weh  as  to  draw  the  blood 
from  the  pelvic  organs  to  the  surface  muscles. 

76.  Bent  Knee  Separation  and  Closing  (Re- 
clining).— The  patient,  reclining,  bends  his  knees  to 
a  right  angle,  the.  feet  resting  on  the  bed  or  chair ;  the 
operator  puts  his  hands  on  the  outside  of  each  knee 


Fig.  36. — Bent  Knee  Separation  and  Closing. 


(Fig.  36)  and  resists  when  the  patient  separates  the 
knees ;  then  the  operator  changes  his  hands  to  the  in- 
side of  the  knees  and  resists  while  the  patient  closes 
them,  "concentric."     Repeated  four  to  ten  times. 

Often  the  movement  is  reversed,  so  that  the  oper- 
ator separates  and  closes  the  knees  when  the  patient 
resists,  "excentric." 

The  feet  should  be  kept  firm  in  their  place  during 
the  mo^  ing  of  the  knees. 


RESISTIVE    MO\EMEi\TS    OE   THE    LEGS.         87 

This  brinc^s  into  play  both  the  aiKhiclors  aiul  the 
abihictors  and  strengthens  the  liips  and  thighs,  and 
the  iloor  of  the  i>elvis,  and  by  its  derivative  effect  from 
the  pelvic  organs  is  an  excellent  exercise  in  diseases 
of"  these  organs. 

jj.  Lkg  Torsion  (Lying). — The  i)atient  keeps  his 
legs  straight  and  the  operator  takes  iK^ld  of  the  feet 
and  resists  while  the  patient  twists  his  legs  out  and 
inward  by  opening  and  closing  the  feet,  the  heels  being 
kept  together.     Repeated  five  to  ten  times. 

This  is  useful  in  stiffness  and  weakness  of  the  hip- 
joint  and  as  a  derivative  from  the  organs  of  the  jielvis. 


CHAPTER  XI. 
Passive  and  Resistive  Movements  of  the  Trunk. 

78.  Trunk  Rotation  (Astride  Sitting — Pas- 
sive).— The  patient  sits  astride  over  a  box  or  stool, 
while  the  operator,  standing  behind,  takes  hold  of  the 
patient's  shoulders  and  moves  his  trunk  from  the  waist, 
describing  as  large  a  circle  as  possible,  first  six  to  four- 
teen times  in  one  direction,  then  as  many  times;  in  the 
other.  The  patient  should  be  perfectly  passive  and  al- 
low the  operator  to  move  him  without  resistance,  and 
therefore  it  would  be  well  to  have  some  person  to  sup- 
port the  patient's  knees. 

This  acts  strongly  on  the  portal  system  of  the  cir- 
culation, strengthens  the  muscles  of  the  waist,  and  has 
a  cjuieting  effect. 

79.  Tritnk  Torsion  (Sitting — Resistive). — 
The  patient  sits  on  a  stool  or  lounge,  with  hands  on 
hips  ;  the  operator,  standing  behind,  puts  his  right  hand 
on  the  front  of  the  patient's  right  shoulder  and  his  left 
hand  on  the  back  of  his  left  shoulder,  and  resists  tlie 
patient  when  he  twists  his  trunk  to  the  left  (Fig.  37). 
Then  the  operator  changes  his  grip,  reverses  his  hands, 
and  resists  when  the  patient  turns  to  the  right.  Re- 
peated four  to  eight  times  on  each  side. 

80.  Trunk  Torsion  (Kneeling — Resistive). — 
The  patient  kneels  on  a  lounge  with  hands  on  hips. 

(88) 


MOVEMENTS    OF   THE    TRUNK. 


89 


The  operator,  staiulini;"  behind  and  lixing  the  patient's 
I)ack  with  one  knee,  takes  hold  and  resists,  as  in  the 
former  movement  (Fig.  2)7) • 

P)Oth  of  these  movements  have  a  good  effect  on  the 
spine,  the  nerves,  and  circulation;  the  former  has  a 


Fig.  37. — Trunk  Torsion    (Kneeling). 


Special  effect  on  the  respiration,  and  the  latter  on  the 
digestion,  by  strengthening  and  elevating  the  muscles 
of  the  abdomen. 

8i.  Forward  Trunk  Flexion  and  Extension 
(Sitting — Resistive). — The  patient,  sitting  on  a 
lounge  or  stool,  with  hands  on  hips,  bends  forward, 
and,  Avhile  rising  up  to  the  former  position,  the  oper- 


90 


PR.\CTiCAL    MASSAGE. 


ator  puts  his  hand  on  the  patient's  back  and  resists 
him  (Fig.  38).     Repeated  four  to  ten  times. 

In  this  exercise  all  the  muscles  of  the  back  are 
brought  into  play,  and  the  chest  is  kept  well  expanded ; 
which  makes  it  a  good  respiratory  movement  as  well 


Fig.  38. — Forward  Trunk  Flexion  and  Extension. 


as  a  strengthening  to  the  muscles  of  the  back  and  a 
straightening  of  the  spine. 

82.  Neck  Flexion  and  Extension  (Standing 
OR  Sitting). — The  operator  places  his  one  hand  on 
the  back  of  the  patient's  skull  and  resists  him  when  he 


MUX  liMliXTS    Ui'"    THE    TKL  XK.  91 

l)cn(ls  his  licad  l)ack\varil  as  far  as  possible.     ReiKatcd 
five  to  ten  times. 

This  acts  on  the  muscles  of  the  neck  and  the  upper 
part  of  the  back,  and  on  the*  blood-vessels  and  nerves 
of  the  neck  and  throat.  It  is  a  derivative  from  the 
brain,  and  it  tends  to  straighten  the  upper  part  of  the 
spine.  \\'hen  this  is  given  to  a  patient  in  hanging 
position  it  is  very  effective  in  straightening  the  spine, 
and  therefore  exceedingly  useful  in  the  treatment  of 
cur\atures  of  the  spine  and  round-shouldered  persons. 


CHAPTER  XII. 

Corrective  Active  Exercises  of  Arms. 

The  correct  standing  position  is  most  essential  and 
a  good  method  to  obtain  it  is  to  stand  with  the  back 
agamst  the  wall;  heels,  buttocks,  shoulders,  and  head 
touchnig;  then  try  hard  to  make  the  small  of  the  back 
also  touch  the  wall,— this  will  hardly  be  possible,  but 
the  effort  is  a  very  gooc^  one  to,  create  a  correct 
position. 

83.   Stand  firmly  on   both   feet,   knees  straight, 
without  strain.' 

Hips  e^•en  in  the  same  plane  and  drawn  well  back, 
so  as  to  keep  the  abdomen  in. 

The  chest  raised  well  forward  and  expanded. 
^  The  shoulders  even  in  the  same  plane,  drawn  back 
without  being  pushed  up,  and  without  stiffness. 

The  arms  hanging  down  by  the  sides  in  straight 
•  line  from   the  shoulders  to  tip  of  fingers,  palms^'in 
toward  the  thigh. 

The  head  raised  even  on  the  shoulders,  and  chin 
drawn  well  in. 

The  weight  of  the  body  inclined  a  little  forward  so 
as  to  rest  on  the  balls  of  the  feet,  and  not  on  the  heels. 

A  line  from  the  crown  of  the  head  should  fall  just 
in  front  of  the  ear,  armpit,  hip,  and  knee-cap  to  the 
instep.     (Fig.  39.) 

(92) 


Fig.  39.— Standing  Position. 


Fiff.  42. — Arm  Flins:in£?   (Sideways). 


Fig.  44.— Arm  Flexion  and  Extension. 


Fig.  45. — Arm  Flexion  and  Extension   (Upward). 


ACTIVE    EXERCISES    OF   ARMS.  93 

84.  Shoulder  Circling  (three  to  ten  times). — 
The  shoulders  are  slowly  moved  upward,  l)ackward. 
dowmvard,  and  forward,  so  as  to  describe  a  circle,  the 
arms  hanging  down. 

Inhale  when  shoulders  go  up  and  backward,  and 
exhale  when  they  go  down  and  forward. 

I'his  strengthens  the  chest  and  shoulder  muscles, 
expands  the  lungs,  and'  relieves  the  work  of  the  heart. 
It  increases  the  flow  of  blood  toward  the  heart,  espe- 
cially from  the  brain. 

Useful  in  chronic  catarrh  of  the  air-passag^e,  in 
wenk  heart-action,  and  in  congestion  of  the  brain. 

85.  Arm  Circling  (five  to  twelve  times.  Fig. 
40). — The  fully  extended  arms  are  slowly  moved  up- 
ward, backward,  downward,  and  forward,  so  as  to 
describe  a  conical  figure  in  the  air,  with  the  apex  in 
the  shoulder-joint.  Inhale  and  exhale  as  in  the  former 
exercise.  Keep  the  head  erect  and  motionless,  and  the 
chest  well  expanded.  Effects)  as  the  former,  but 
stronger. 

86.  Arm  Elevation — Forward,  Upward  (se\'en 
to  sixteen  times.  Fig.  41). — The  fully  extended  amis 
are  quickly  raised  forward  and  upward  over  the  head, 
whereby  the  fo-llowing  muscles  are  brought  into  action  : 
The  anterior  portion  of  the  deltoid,  the  upper  pecto- 
ralis  major,  the  short  head  of  the  biceps  and  the  coraco- 
brachialis  bring  the  arms  to  horizontal  position;  from 
this  the  posterior  deltoid,  the  infraspinatus  and  teres 
miinor,  the  trapezius,  and  also  the  rhomboids  and  leva- 
tor anguli  scapula?  raise  the  arms  to  thes  vertical  posi- 
tion.    Concentric  action. 


94  PRACTICAL   MASSAGE. 

NoAV  the  arms  are  lowered  sloAvly  sideways  to  their 
original  position.     Excentric  action. 

Keep  the  chest  well  forward,  head  and  trunk  mo- 
tionless. 

Inhale  when  arms  are  raised ;  exhale  when  they 
are  lowered. 

It  expands  and  elevates  the  chest  and  lung's, 
strengthens  the  nerves  and  muscles  of  the  shoulders, 
limbers  the  shoulder- joints,  and  straightens  the  back. 

Useful  in  narrow  and  weak  chest,  in  weakness  of 
the  respiratory  organs  and  the  heart,  and  corrects 
stooping  shoulders. 

87.  Arm  Flinging — Sideways  (ten  to  sixteen 
times). — The  upper  arms  are  raised  horizontally,  side- 
ways, and  kept  well  back  with  the  forearms  shaq>ly 
bent  upon  them  in  front  (Fig.  42).  From  this  posi- 
tion the  forearms  are  smartly  and  energetically  thrust 
outward  without  moving  the  upper  arms ;  during  this 
movement  inhale,  the  forearms  being  again  bent  for- 
ward to  their  former  position  under  exhalation. 

The  muscles  used  are:  the  deltoid,  supraspinatus, 
trapezius,  levator  anguli  scapul?e,  rhomboids,  biceps 
and  triceps,  and  to  some  extent  the  latissimus  dorsi. 

Strengthens  the  nerves  and  muscles  of  the  arms 
aud  back,  expands  and  widens  the  chest,  straightens 
the  back  and  increases  the  flow  of  blood  to  the  arms. 

If  this  exercise  is  taken  with  the  trunk  bent  for- 
ward (head  up)  it  becomes  a  very  powerful  mo^•e- 
ment  for  the  back. 


ACTIVE   EXERCISES    OF   ARMS.  95 

88.  Arm  Rotation  (ten  to  twenty  times). — Take 
position  as  in  Fig.  43 ;  now  rotate,  or  twist,  lx)tli  arms 
in  the  shoulder-joints  so  as  to  bring-  the  forearms  hori- 
zontally forward,  parallel  with  the  lloor  and  with  each 
other;  the  right  angle  in  the  elbows  is  maintained,  and 
the  upper  arms  kept  in  the  same  height  as  the  shoul- 
ders, with  the  chest  well  expanded. 

Rotate  back  to  the  first  position. 

This  is  an  excellent  exercise  to  straighten  round 
shoulders,  as  it  brings  the  following  muscles  into  strong 
action :  Infraspinatus,  teres  minor,  posterior  deltoid, 
trapezius,  rhomlxDids,  levator  ang'uli  scapulae,  and  latis- 
simus  dorsi. 

In  fonvard  bent  position  it  is  very  effective. 

89.  Arm  Flexion  and  Extension  (Upw^\rd, 
Sideways,  and  Downward). — The  foreanns  are 
slowly  bent  up  against  the  upper  arms,  the  elbows  kept 
close  to  the  sides,  the  fingers  slightly  bent  and  pointed 
toward  the  shoulders  (Fig.  44).  From  this  position 
the  arms  are  energetically  stretched  upward  to  a  verti- 
cal position  a1x)ve  the  head,  the  palms  facing  each 
other  (Fig.  45).  The  arms  are  again  slowly  bent  to 
their  fonner  position  and  then  quickly  stretched  hori- 
zontally sideways,  the  palms  turned  downward  and 
arms  kept  well  back.  Now  bend  the  arms  and  stretch 
them  sharply  downward.  This  alternate  l)cnding'  and 
stretching  to  be  repeated  as'  above  from  eight  to  six- 
teen times ;  the  head  and  back  to  be  kept  upright  during 
the  movement,  and  shoulders  well  back. 

Strengiihens  the  muscles  and  nen-es  of  the  arms 


96  PRACTICAL   MASSAGE. 

and  shoulders,  widens  the  chest,  limbers  the  joints,  in- 
creases the  circulation  of  the  blood,  and  strengthens 
the  energy  of  the  heart  and  lungs. 

Useful  in  rheumatism  and  stiffness  of  the  anns; 
in  weakness  of  nerves  and  muscles ;  to  draw  the  blood 
away  from  the  chest  and  head ;  as  a  means  of  warming, 
to  prevent  taking  colds,  and  to  energize  the  action  of 
the  heart. 

In  case  of  one  shoulder  lower  than  the  other, 
stretch  the  corresponding  arm  upward  and  the  other 
arm  downward. 


CHAPTER  XTTT. 
Corrective  Active  Exercises  of  Legs. 

(JO.  Leg  Elevation — Sideways  (five  to  ten  times). 
— \\  ith  the  hands  placed  on  the  hips,  or  hohhng  on  to 
a  chair  or  a  table,  raise  one  leg  slowly  up  sideways; 
repeat  five  to  ten  times  with  each  leg.  After  some 
practice  the  amis  may  be  raised  sideways  (Fig.  46). 

Brings  into  strong  action :  the  glutei  muscles,  ten- 
soT  \-agin3e  femoris,  pyriformis,  gemelli,  sartorius,  ob- 
turator internus,  and,  as  all  balancing  exercises,  has 
a  strengthening  effect  on  the  nervous  system.  It  is 
also  useful  in  weakness  of  the  organs  of  the  pelvis,  and 
to  reduce  large  hips. 

91.  Leg  Elevation  (Eorward). — Raise  the  leg 
slowly  forward  as  high  as  possible  without  bending 
the  body,  then  lower  it  slowly,  and  repeat  five  to  ten 
times  with  each  leg;  stretch  the  foot  well  (Fig.  47). 

Here  the  abdominal  muscles  and  flexors  of  the 
thigh  and  extensors  of  the  leg  are  strongly  contracted, 
viz.,  psoas  magnus,  iliacus,  sartorius,  pectineus,  graci- 
lis, gluteus  minimus,  obturator  externus,  tensor  vaginae 
femoris  and  rectus  femoris. 

At  the  same  time  the  hamstrings  and  sciatic  nerve 
are  passively  stretched. 

Useful  in  sciatic  neuralgia,  in  stiffness  of  the  joints, 
in  constipation,  in  weakness  of  the  pelvis,  and  in 
obesity. 

■^  (97) 


98  .  PRACTICAL   MASSAGE. 

92.  Leg  Elevation  (Backward). — With  hands 
on  hips,  raise  one  leg  backward,  without  bending  the 
tniiik  or  knees ;  point  the  toes  well  back  and  down ; 
keep  the  chest  well  forward;  repeat  five  to  ten  times. 
Later  with  hands  on  neck '(Fig.  48.) 

Contraction  of :  gluteus  maximus,  gluteus  medius, 
pyriformis,  obturator  internus,  gemellus,  cjuadratus 
femoris,  long  head  of  biceps  femoris,  posterior  part 
adductor  magnus. 

Also  passive  stretching  of  the  abdominal  and  flexor 
muscles  of  the  thigh. 

Fine  balancing  exercise  and.  to  straighten  the  back 
and  produce  an  easy  and  graceful  carriage  of  the  body. 

93.  Knees  Bend  (Deep). — Raise  the  heels,  then 
bend  the  knees  slowly  way  down ;  keep  the  knees  well 
out  o\'er  the  toes ;  then  straighten  knees  slowly ;  repeat 
three  to  ten  times;  keep  chest  out  and  back  erect  (Fig, 

49)- 

Very  strong  exercise  for  the  hip-joint  extensors 
and  abductors,  viz.,  the  hamstring  muscles,  glutei  and 
tensor  fasciae  latre ;  the  quadriceps  extensors  of  the 
knee;  the  gastrocnemius,  soleus,  plantaris  and  other 
extensors  of  the  foot.  First  "excentric,"  then 
"concentric." 

The  erector  spina:  is  strongly  contracted  all  through 
the  movement  to  keep  the  trunk  erect. 

This  exercise  therefore  is  very  valuable  for  the  in- 
crease in  size  and  strength  of  all  these  large  muscles 
of  the  lower  trunk  and  the  legs ;  to  limber  the  knees 
and  ankle-joints ;  strengthen  the  nerves  and  muscles 


ACTIVE  EXERCISES   OF   LEGS.  99 

of  the  loins  and  alxlomcn  ;  quicken  the  circulation  of 
hloocl  toward  the*  leg's,  and  streng-thcn  the  organs  of 
the  pelvis  and  the  action  of  the  intestines. 

Useful  in  weakness  of  the  nerves  and  muscles  of 
the  lower  limbs,  in  sciatica,  ix)or  digestion,  hemor- 
rhoids, weakness  of  the  pel\-is,  curvature  of  the  spine, 
and!  to  counteract  too  strong  flow  of  l)lood  to  internal 
organs. 

94.  Heel  Elevation  (ten  to  thirty  times). — 
Keep  heels  together  and  raise  them,  quickly  as  high  as 
possible  without  beuding  the  knees  or  trtmk,  then  sink 
heels  slow'ly  and  raise  again  ten  to  thirty  times. 

Strengthens  the  nerves  and  muscles  of  the  legs  and 
feet  (enlarges  the  calves),  and  straightens  the  back. 

In  case  of  "flat-foot,"  raise  the  heels  and  turn  toes 
in  and  heels  outward. 

95.  Charge — or  Fall  out — Forward. — Right 
foot  is  placed  forward,  leaving  a  distance  of  three 
times  the  length  of  the  foot  between  the  heels.  The 
forw^ard  knee  is  bent  to  a  right  angle  and  over  the 
foot  (Fig.  50).  The  body  is  at  once  advanced  so  that 
the  back  and  rear  leg,  which  is  kept  sraight,  are  in 
the  same  plane  (Fig.  51).  Head  up  and  both  feet 
firmly  on  the  floor. 

This  movement  consists  of:  flexion  and  some  ab- 
duction in  the  right  hip-joint ;  flexion  in  the  right 
knee-  and  ankle-  joints ;  rotation  outward  in  the  left 
hip-joint ;  some  rotation  to  the  left  of  the  pelvis ;  some 
twist  oi  the  spine  to  the  right,  with  a  slight  bend  to 
the}  same  side  and  convexity  to  the  left. 


100  PRACTICAL   MASSAGE. 

The  psoas,  iliacus  and  rectus  femoris  muscles  of 
the  right  thigh  raise  it ;  when  the  foot  strikes  the  floor 
the  right  hip-,  knee-,  and  ankle-  joint  extensors  con- 
tract to  check  the  flexion  in  these  joints.  There  is 
alsb  a  strong'  contraction  oi  the  left  glutei,  hamstring, 
and  quadriceps  muscles,  as  well  as  the  inward  rotators 
— tensor  fascise  latse,  anterior  part  of  gluteus  medius 
and  minimus.  The  left  foot  is  kept  fimily  on  the  floor 
by  the  left  hip-joint  adductors  and  by  the  tibialis  anti- 
cus  and  posticus.  The  whole  erector  spinas  group  on 
each  side  is  strongly  contracted ;  the  left)  external  and 
right  internali  oblique  abdominal  muscles,  the  left  ser- 
ratus  posticus  superior  and  right  serratus  posticus  in- 
ferior, etc.,  are  also  brought  into  strong  action ;  and 
z'icc  versa  when  the  feet  are  changed. 

.  The  mo'vement  is  very  efl^ective  as  a  general  exer- 
cise as  well  as  in  cases  of  curvature  of  the  spine,  using 
one  or  the  other  side  according  to  the  case. 

By  stretching  one  or  bothi  arms  over  the  head  and 
also  bending  the  trunk  forward  this  movement  becomes 
an  exceedingly  strong  exercise  for  the  back. 

96.  Horizontal  balance — standing  (Fig.  52) 
is  another  very  powerful  movement  for  the  straighten- 
ing and  strengthening  of  the  spine  and  back  muscles. 

97.  "Back-curving/'  or  prone  lying,  trunk 
RAISED  BACKWARD  (Fig.  53)  is  probably  the  best  and 
strongest  movement  to*  counteract  double  curvature  oi 
the  spine,  as  all  the  muscles  of  the  back,  hip-joint  ex- 
tensors and  adductors  O'f  the  scapukne  are  vigorously 
contracting.  It  is  also  very  effective  for  round 
shoulders  and  narrow  chest. 


Fig.  47. — Leg  Elevaiiun   (^Forward). 


Fig.  49. — Knees  Bend  (Deep). 


Fig.  SO.-rharge-or  Fall  out       Fig.  52.-Horizontai    MalancV  (Standin-) 
— Forward.  '^ 


Fig.  53. — Back  Curving. 


Fie.  54. — Lefj  Elevation   CLving-). 


ACTIVE   EXERCISES   OF   LEGS.  101 

But  it  produces  a  considerable  liiin1)ar  hyi^erex- 
tension,  and  should  therefore  always  l>e  followed  by 

98.  Leg  Elevation — Lying  (three  to  eii^ht 
times). — Lying  on  the  back,  first  pull  Ixjth  knees  u\) 
toward  the  chest  (as  high  as  possible)  ;  then  straighten 
the  legs  up  (h'ig.  54),  and  lower  them  slowly  to  45 
degrees,  when  they  should  be  bent  with  the  feet  rest- 
ing on  the  couch.  This  will  prevent  the  excessive 
lumbar  anterior  curve,  and  should  be  given  frequently 
in  cases  of  "lordosis." 

It  also  strengthens  the  abdominal  muscles  and  the 
action  of  the  Ijowels,  stretches  the  sciatic  nen-e,  and 
reduces  obesity. 


CHAPTER  XIV. 

Corrective  Active  Exercises  of  Head  and  Trunk. 

99.  Head  Bending — Backward  (five  to  ten 
times). — The  head  is  bent  slowly  backward  with  a 
strong  pull  of  the  back  and  posterior  neck  muscles,  re- 
sisted gently  by  the  flexors  of  the  head  and  neck —  rec- 
tus capitis,  anticus  major  and  minor,  longus  co'lli,  sca- 
leni,  and  the  small  muscles  numing  between  the  stern- 
urni,  hyoid  bone,  and  lower  jaw — or,  as  we  say,  "draw 
in  the  chin."  The  two  sets  of  muscles  thus  working 
against  each  other,  the  posterior  in  excess  ol  the  an- 
terior, keeiif  the  head  steady  on  the  top  of  the  cervical 
spine,  produce  a  straightening  of  the  latter,  bind,  the 
two  togetlier  and  make  them  move  backward  as  one 
piece. 

It  is  valuable  for  the  cultivation  of  good  posture 
of  the  head,  for  impro'ving  the  muscles  o£  the  neck, 
straightening^  the  upper  spine,  and  to  produce  a  mod- 
erate expansion  of  the  upper  chest. 

100.  Trunk  Flexion — Backward  (Fig.  55). — 
With  the  hands  on  hips  the  trunk  is  slowly  bent  back- 
ward at  the  dorsal  region,  raising  and  arching  the 
chest  and  holding  the  abdomiinal  muscles  in  so  as  not 
to  bend  at  the  lumbar  region,  and  keeping  the  legs  firm 
and  straight. 

If  done  well,   this  exercise  produces   a   powerful 
(102) 


ACTIVE    EXERCISES    OE   THE   TRUNK.  103 

contraction  of  all  the  Ixick  nniscles  of  tiic  thoracic 
spine,  viz.,  trapezius,  rhonilxnds,  latissinnis  dorsi, 
serratus  posticus  su])erior  and  inferior,  erector  spin;e, 
sacrolunibahs,  spinalis  dorsi,  semispinalis  dorsi,  and 
also  by  the  depressors  of  the  scapula :  lower  serratus 
magnus  and  pcctoralis  minor.  This  again  will  elevate 
the  ribs. 

A  complete  straightening  of  the|  dorsal  spine  and 
a  considerable  expansion  of  the  chest  through  the 
stretching  of  costovertebral,  ligaments  will  ensue. 

If  this  exercise  is  taken  with  inhalation,  which  is 
a  good  way  to  teach  l>eginners  to  do  the  exercise  cor- 
rectly, the  following  muscles  will  also  be  active,  viz., 
external  intercostals,  anterior  i>ortion  of  "internal  inter- 
costals,  levatores  costarum,  scaleni,  sternomastoid,  and 
suljclavius. 

In  such  case  the  l)ackward  flexion  should  immedi- 
ately l3e  followed  by  the  raising  of  the  trunk,  wath 
exhalation. 

Later  on  this  exercise  should  l^e  practised  with 
hands  on  neck. 

Very  useful  in  narrow  and  contracted  chest  and 
round  shoulders ;  in  weakness  of  the  lungs,  curvature 
of  the  spine,  and  to  produce  a  correct  and  upright 
posture. 

loi.  Trunk  Flexion  (Forward). — Hands  on 
hips,  later  on  neck,  and  stretched  over  head  (Figs.  56 
and  57),  the  trunk  is  l)ent  forward  from  the  hips  and 
kept  in  this  position  for  awhile,  w'ith  the  shoulders 
and  head  well  back  and  chin  in,  the  chest  well  forward 
and  the  knees  straig-ht. 


104  PRACTICAL   MASSAGE. 

This  exercise  begins  with  a  contraction  of  the  ab- 
dominal muscles  and  continues  by  gravity.  Now  all 
the  back  muscles  and  posterior  hip  muscles  are  con- 
tracting vigorously  to  keep  the  spine  straight — the 
more  so,  the  longer  the  position  is  held ;  and  the  same 
muscles  will  again  raise  the  trunk  tO'  the  erect  position. 

Very  valuable  to  strengthen  the  back  and  straighten 
the  spine. 

102.  Chopping  Movement. — ^Standing  with  feet 
apart  and  arms  over  head,  bend  the  iDody  quickly  for- 
ward and  downward,  and  fling  the  arms  to  the  floor; 
then  raise  the  body  and  bend  a  little  backward  with 
arms  and  head  well  back;  repeat  six  to  twenty  times. 

This  strengthens  the  nerves  and  muscles  of  the 
back,  arms,  and  abdomen,  and  increases  the  action  of 
the  organs  of  the  pelvis,  as  well  as  the  stomach,  liver, 
and  intestines.     It  should  be  followed  by 

103.  Harvesting  Movement  (Figs.  58  and  59). 
— The  patient  bends  the  trunk  forward.  Now  fling 
the  arms  forcibly  from  one  side  to  the  other  and  twist 
the  trunk  with  them ;  repeat  ten  to  thirty  times. 

This  com]Diletes  the  effect  of  the  former  exercise, 
increases  the  circulation  of  the  blood,  strengthens  the 
nerves  and  miuscles;  of  the  chest  and  back,  shonlders, 
and  loins,  and  is  of  great  value  in  li^'er  and  stomach 
troubles  and  obesity. 

104.  Trunk  Flexion  (Sideways). — The  trunk 
is  bent  alternately  to  the  left  and  right,  as  far  as  pos- 
sible without  twisting  (Fig.  60),  first  with  hands  on 
hips,  later  on  neck  or  sideways,  etc. 


l"iy".  5o.— Trunk  i'lexion    (Forward). 


Fig,  57. — Trunk  I'lcxion   (Forward). 


Fig.  60. — Trunk  Flexion    (Sideways"). 


Fig.  61. — Trunk  Torsion. 


Fig.  63. — Body  Horizontal. 


ACTIVE    EXERCISES    OF   THE    TRUNK.  105 

The  alxlominal  muscles,  lower  erector  spiiKV  and 
olnteiis  luaxinnis,  giuteus  niedius,  gluteus  niiniiuus, 
and  tensor  fjusciic  latjc  contract  to  Ix'gin  the  movement 
on  the  left  side;  then  gravity  becomes  the  motor  force, 
while  the  same  muscles  on  the  right  side  contract  "ex- 
centrically"  to  hokl  the  bcxly,  until,  by  shortening,  they 
raise  the  trunk  to  the  original  position  and  start  the 
movement  to  the  right,  when  the  muscles'  on  the  left 
beg"in  to  \vork. 

Besides  being  a  jxjwerful  exercise  for  these  mus- 
cles, it  also  acts  strongly  on  the  floAv  of  blood  through 
llie  inferior  vena  cava  and  the  portal  system,  and 
therefore  is  an  excellent  exercise  for  constipation  and 
Ii\'er  troubles. 

105.  Trunk  Torsion  (Fig.  61). — The  trunk  is 
turned  (rotated)  round  its  long  axis  alternately  to  the 
left  and  right,  without  moving  the  hips,  so  as  to  make 
the  whole  movement  alx)ve  the  hips  with  the  head 
immovable  with  the  shoulders. 

This  employs  the  whole  range  of  rotation  in  the 
thoracic  spine,  and  a  small  amount  in  the  lumbar 
region,  while  the  cerx^ical  spine,  the  pelvis,  the  hii>-, 
knee-,  and  ankle-  joints  reniain  fixed  in  the  funda- 
mental position,  by  a  strong  muscular  effort. 

The  oblique  alxlominal  and  back  muscles  are  di- 
rectly concerned  in  this  movement:  and  practically  all 
the  muscles  of  the  hips  and  lower  extremities,  includ- 
ing the  inverters  of  the  feet,  contract  in  the  effort  to 
fix  the  pelvis  and  legs. 

It  is  a  strong  abdominal  exercise,  and  probably  a 


106  PRACTICAL   MASSAGE. 

better  "reducer"  of  obesity  than  any  of  the  former; 
and  owing  to  the  strong  contraction  of  the  tibiahs 
anticus  and  posticus  and  plantar  muscles,  it  is  also 
strengthening-  to^  the  arches  O'f  the  feet. 

io6.  Trunk  Circling  (three  to  eight  times).— 
With  the  hands  on  hips  and  feet  apart,  bend  the  trunk 
forward,  then  to)  the  left  side,  then  backward,  then  to 
the  right  and  forward,  describing  as  large  a  circle  as 
possible  from  the  waist. 

The  trunk  should  not  be  twisted,  but  kept  square 
to  the  front  throughout  the  whole  movement,  the  chest 
well  expanded,,  the  hips,  shoulders,  and  head  steady, 
and  the  legs  straight.  When  the  circling  has  been 
done  from  three  to  eight  times  in  one  direction,  it 
should  be  repeated  as  many  times  in  the  other. 

The  effects  of  this  movement  are  to  strengthen  the 
muscles  of  the  abdomen,  the  sides,  and  back ;  limber 
the  back  and  loins,  stimulate  the  spine  and  its  nerves; 
assist  the  action  of  the  liver,  stomach,  kidneys,  and 
intestines,  and  to  increase  the  oortal  system  of  the 
circulation. 

107.  Trunk  Elevation  (Lying)  (Fig.  62). — 
The  patient,  lying  on  a  lounge  or  bed,  with  his  legs 
hanging  down,  raise  his  body  to  a  sitting  position, 
while  somebody  holds  down  his  knees ;  or  it  may  be 
practised  sitting  on  the  floor  or  a  stool,  Mnth  the  feet 
held  under  a  bureau,  etc.,  and  the  body  raised  and 
lowered  according  to  the  strength  of  the  patient. 

The  movement  should  be  done  only  at  the  hips, 
without  any  lumbar  hyperextension ;  the  back  straight, 
the  head  well  back,  and)  the  chest  expanded. 


ACTIVE    EXERCISES    OF    THE    TRLXK.  107 

The  flexors  of  the  hip-joint,  viz.,  the  ps^>as,  ihacus, 
sartorius,  and  pcctineus,  are  here  stroni^ly  contracted, 
which  again  demand  a  vigorous  contraction  of  the 
abdominal  muscles. 

The  upper  back  muscles  nmst  also  be  well  con- 
tracted in  order  to  hold  tlie  1)ack  straight  and  chest 
expanded;  otherwise  the  upper  part  of  the  body  will 


Fig.  62. — Trunk  Elevation  (Lying). 

be  "curled,"  the  shoulders  and  head  drawn  forward, 
and  the  chest  depressed,  which  would  result  in  a  very 
faulty  position. 

When  properly  executed,  this  movement  is  one  of 
the  most  powerful  abdominal  exercises,  and  gives  ex- 
cellent training  in  the  kind  of  muscular  control  required 
for  a  good  carriage  of  both  the  upper  and  lower  parts 
of  the  body. 


108  PRACTICAL   MASSAGE. 

Care  should  be  taken  to  begin  gently,  and  never 
to  allow  "tremors"  to  appear. 

io8.  Body  Horizontal  on  Toes  and  Hands 
(Fig-.  63)  or  on  the  Bent  Elbows  and  Toes. — • 
Keep  the  whole  body  in  one  horizontal  line  for  a  few 
seconds ;  then  rest  by  lowering  the  trunk  to  the  floor, 
and  again  raise  up  to  the  first  position.  Repeat  two 
to  six  times. 

Elffects  a  muscular  contraction  of  the  front  part  of 
the  abdomen  and  pehis ;  ^■iscera  gravitate  forward ; 
the  chest  is  expanded,  and  elevation  of  internal  organs 
results.  The  blood  is  drawn  into  the  anterior  portion 
of  the  bo'dy,  away  from  the  spine. 

Useful  in  prolapsus  of  the  uterus,  vagina,  or  rec- 
tum, and  in  obesity. 


CHAPTER  XV. 
Stiffness  of  Joints  and  Tendons. 

From  Dr.  Schreiber  the  following  is  quoted: — 

"It  not  infrequently  happens  that,  after  arthritis, 
thickening  of  the  periarthritic  structures  or  even  adhe- 
sion of  the  articular  surfaces  themselves  may  occur, 
leading  to  very  considerable  disability  of  motions. 
Only  by  mechanical  means  can  we  then  hope  toi  break 
up  the  existing  adhesions,  to  smooth  the  roughened 
articular  cartilages,  and  to  restore  tO'  the  ligaments 
their  fonner  suppleness  and  elasticity. 

"All  the  mechanical  interferences  used — pressing, 
stroking,  kneading — as  well  as  the  passive  exercises — 
must  be  performed  with  the  greatest  care,  since  it  is 
quite  p<issible  tO'  initiate  fresh  inflammatoiy  action  by 
injudicious  treatment. 

"The  successful  treatment  of  these  cases  affords  one 
of  the  most  difficult  problems  of  the  niechano-therapist, 
for  it  requires  untiring  perseverance  and  patience,  as 
well  as  nice  judgment  and  all  the  fruits  gained  by  ex- 
perience, to  tide  the  patient  over  the  necessary  pain 
which  for  months  he  may  be  called  upon  to  bear. 

"The  modus  operandi  in  each  case  will  be  indicated 
by  the  mechanism^  of  the  particular  joint  to^  be  treated, 
which  sometimes  will  be  found  to  l)e  immovably  fixed. 
At  first  the  tissues  surrounding  the  joint   are  to  l>e 

(109) 


110  PRACTICAL  MASSAGE. 

gently  rubbed,  using'  in  the  beginning  the  finger-tips 
only;  later,  the  force  may  be  increased. 

"As  soon  as  the  part  has,  in  a  measure,  become 
accustomed  to  the  pain,  the  passive  motions  suitable  to 
the  joint  may  be  begun. 

"The  adhesions  existing  within  and  around  the 
joint  may  be  of  so  firm  and  resistant  a  nature  as  to 
readily  lead  to  the  belief  in  the  existence  of  lx)ny 
ankylosis.  At  first  the  amount  of  motion  obtained  in 
the  joint  will  be  exceedingly  small,  but  even  with  this 
we  will  be  bound  to  rest  satisfied,  for  an  increase  of 
mobility  often  does  not  begin  for  months ;  in  the  mean- 
while the  patience  of  both  physician  and  patient  will 
necessarily  be  put  to  a  severe  test.  Nevertheless,  keep- 
ing in  mind  the  old  saying,  .that  'constant  dropping 
wears  away  the  rock,'  troatment  must  be  continued 
steadily  and  systematically. 

"The  astonishing  results  which  experienced  me- 
chano-therapists  often  obtain  in  cases  declared  incur- 
able by  others  can  often  be  explained  by  the  consistent 
and  methodical  treatment  which  they  pursue. 

"The  knee-joint  is  very  often  the  seat  of  extensive 
synovial  exudation  in  consequence  of  chronic'  rheuma- 
tism. Resorption  is  to  be  effected  as  in  synovitis  in 
general,  namely,  by  centripetal  stroking,  pressing,  and 
kneading." 

The  following  is  an  interesting  case  of  stiffness,  of 
the  right  shoulder  which  I  treated  a  few  years  ago^: — 

A  rather  feeble  lady,  about  45  years  of  age,  was 
struck  on  her  right  forearm.     There  was  no  fracture 


STIFFNESS   OF   JOINTS    AND   TENDONS.       m 

nor  sprain,  but  the  arm  was  kept  in  a  sling  for  two 
months.  Then  the  lady  found  that  she  could  hardly 
move  her  arm  at  the  shoulder-joint.  The  adliesions 
were  broken  up.  During  the  oi>eration  the  slioulder 
was  mechanically  dislocated  and  reset.  InHammatory 
adhesions  followed,  and  the  operation  was  rei>eated 
with  no  better  result.  The  joint  was  stiff,  with  great 
inflammation  of  the  deltoid  and  the  adjacent  nerves 
and  tendons,  and  so  tender  and  sore  that  it  could  not 
be  touched  when  the  ph^-sician  prescribed  massage. 

The  patient  being  under  the  influence  of  an  injec- 
tion of  morphine  administered  by  the  physician,  the 
writer  was  enabled  to  apply  treatment  consisting  of 
centripetal  kneading  and  stroking.  After  a  few  days 
the  injection  was  discontinued  and  passive  motions 
were  applied,  in  addition  to  the  manipulations.  Two 
weeks  later  active  and  resistive  movements  were  used. 
After  two  months'  treatment  the  patient  was  well. 

My  method  now  in  treating-  stiff  joints  is  to  put 
the  contracted  nmscles  on  a  passive,  but  strong  ex- 
tension and,  while  holding  them  in  this  position,  apply 
centripetal  stroking,  quite  hard  circular  kneading,  and 
vigorous  vibration  on  the  extended  contracted  parts ; 
also  muscle  kneading  and  percussion  on  the  antagonists 
so  as  to  make  them  stronger.  I  have  found  that  in 
most  of  these  cases — after  the  inflammation  had  left 
— the  more  strength  the  operator  can  use  in  bending 
and  stretching  the  joint  passively,  thei  quicker  it  wdll 
be  well ;  but,  of  course,  care  must  be  taken  not  to  over- 
do it  or  to  fracture  some  bone,     ^^'e  must  find  out 


112  PRACTICAL   MASSAGE. 

exactly  which  muscle  or  muscles  are  the  contracted 
ones  and  which  are  the  weak  ones,  and  treat  themi  ac- 
cordingly. Sometimes  we  find,  after  we  have  been 
treating-  a  joint-affection  qnite  roughly  for  weeks  and 
months,  that  neuritis  has  set  in,  and  then  the  treat- 
ment must  be  altered  altogether,  otherwise  we  shall 
gO'  from  bad  to  worse.  Neuritis,  as  will  be  seen  later, 
is  to  be  treated  very  gently  and  not  with  centripetal 
strokings  and  kneading^s. 

As  soon  as  the  patient  is  able,  he  should  be  encour- 
aged to  move  the  jonit,  and  be  given  resistive  exercises 
for  the  weak  muscles ;  thereby  he,  himself,  passively 
stretches  the  contracted  muscles. 

One  great  mistake  is  often  made  by  masseurs,  viz., 
to  apply  massag-e  too  long-  at  a  time.  IMuch  harm  may 
te  and  has  been  done  by  long  treatment,  while  no  hann 
will  ever  occur  by  too  short  a  treatment.  It  is  safer 
to  make  it  tooi  short  than  too  long,  especially  if  the 
treatment  is  strong  and  vigorous.  Ten  to^  fifteen  min- 
utes suffice;  sometimes  even  less  will  be  better. 
Remember  that  moderate  muscle  kneading  and  percus- 
sion make  muscles  contract  and  become  stronger,  while 
circular  kneading — especially  strong — and  vigorous 
vibration  loosen  the  muscles,  and  still  more  so'  when 
the  muscles  are  kept  on  the  "stretch." 

At  times  it  is  necessary  to  lift  some  muscles  either 
by  one  hand  or  by  certain  positions  on  the  part  of  the 
patient,  and  with  the  other  hand,  or  fingers,  knead 
under  and  aronnd  them  to  break  up  adhesions ;  but  all 
these  different  manipulations  must  be  seen  or  learned 
by  long  experience. 


SPRAIXS.    SYNOVITIS,    ETC.  113 

I  could  give  hundreds  of  cases  which  I  have  treated 
with  good  success  by  thi's  method ;  but  my  success  at 
the  chnic  in  Boston  City  Hospital,  which  has  gained 
the  appnnal  and  praise  of  the  head  surgeons  there, 
must  be  enough  to  prove  the  merits  of  my  metho<l. 

Sprains,  Synovitis,  Hydrartriius  (Water  on 
THE  Knee),  "Ctiarley-horse,"  etc. — In  my  opinion 
such  afllictions  should  be  given  massage  as  soon  as 
possible.  Tliis  I  am  also  able  to  back,  up  with  many 
successful  cases.  One  of  my  sons,  as  captain  of  M. 
A.  H.  football  team,  one  Saturday  was  badly  injured, 
and  the  coach  looking  at  himi  said :  "You  have  water 
on  that  knee;  it  will  be  the  last  of  your  playing  this 
season,"  at  which  the  boy  answered  that  he  was  not 
so  sure  about  that,  as  he  was  going  to  see  "Dad." 
\Xe\\,  "Dad"  just  applied  hot  water  on  the  knee  for 
about  fifteen  minutes;  then  gave  light  "combination" 
kneading  of  the  thigh,  beginning  at  the  hip  all  around 
toward  the  knee.  ])ut  not  touching  it,  followed  by  cen- 
tripetal stroking  from  the  knee  and  up  the  whole  thigh, 
especially  the  inside,  where  the  big  veins  are;  also 
some  stroking  from  the  foot  and  up,  avoiding  the 
knee. 

This  was  done  for  ten  minutes,  three  times  a  day 
the  first  few  days  and  then  twice  a  day;  and  the  fol- 
lowing Saturday  the  boy  played  a  winning  game  as 
half-back.  Some  time  later  he  was  struck,  and  a 
"Charley-horse"  appeared.  T  gave  the  same  treatment 
and  also  circular  kneading  right  oni  the  spot  for  three 
davs,  and  all  was  well. 


114  PRACTICAL   MASSAGE. 

In  sprains  I  have  had  hundreds  of  similar*  cases. 

Batlie  the  parts  in  hot  water  immediately  after  the 
accident,  then  apply  "combination"  kneading  from 
above  and  gradually  move  down  toward  the  sprain, 
stopping  before  it  is  reached ;  then  centripetal  stroking. 
When  the  soreness  has  disappeared  give  gentle  circu- 
lar kneading  all  around  the  joint,  followed  by  strok- 
ing; also  apply  circular  kneading  with  one  hand  while 
centripetal  stroking  is  applied  with  the  other  hand. 

Provided  no  ligament  is  torn,  a  sprained  ankle,  if 
treated  at  once,  should  be  well  in  from  two  to  six 
days.  If  a  ligament  is  tO'm  the  massage  is  still  of 
great  help,  but  the  sore  spots  must  not  l>e  touched ; 
all  the  massage  is  to  be  above  and  below. 

Of  course,  there  are  cases  when  massage  had  better 
not  be  used. 

For  instance,  if  a  muscle  is  ruptured  throug'h  over- 
work, it  should  be  "plastered"  up  till  it  is  healed;  then 
gentle  kneading  may  be  good. 

The  most  cases  of  sprains  which  are  treated  with 
massage  stop  too'  soon.  Especially  is  this  the  case 
where  the  sprain  is  an  old  one.  Here  the  muscles  have 
become  very  weak  through  the  long  inactivity.  There- 
fore, whenever  a  sprain  is  seemiingly  well — that  is, 
pain  is  gone — passive  rotations,  flexions,  and  exten- 
sions should  be  applied;  and  also'  resistive  movements 
to  make  the  muscles  strong  again,  and  even  stronger 
than  before,  so  they  will  not  allow  of  any  more  sprains 
to  that  joint. 

Persons  who'  frequently  "turn"   the  foot  do   this 


SPRAIN'S,    SYNOVITIS,   ETC.  115 

because  the  ligaments  arc  "slack,"  and  as  we  cannot 
niake  tliein  shorten,  we  must  make  the  muscles  strong 
enough,  to  act  for  the  ligaments  as  well. 

Old  sprains,  when  the  inflammation  has  disap- 
peared, are  treated  like  stiff  joints,  often  with  great 
force. 

Syjioz'itis  is  best  treated  with  centripetal  stnjking 
above  the  diseased  part  and,  better,  ten  minutes  twice 
a  day;  then  not  so  frequently. 

These  different  traumatic  cases,  when;  no  fractures 
occur,  if  treated  early  and  by  an  expert,  will  most 
frequently  be  cured  in  quite  a  short  time,  while  if  they 
have  been  allowed  to  go  on  for  months  and  even  years, 
this  treatment  will  still  prove  to  be  most  effective,  and 
on  the  average  in  these  old  cases  a  cure  may  be  ef- 
fected in  from  one  to  three  months. 

Other  joints  are  treated  on  the  same  plan. 

The  hip-  and  shoulder-  joints  are  more  difficult  to 
treat  and  require  a  much  longer  time  in  order  to  pro- 
duce a  cure. 

The  following-cited  cases  are  especially  note- 
worthy : — 

Ca.se  I. — A  gentleman,  36  years  old,  sprained  his 
right  ankle  by  a  fall,  and  had  been  on  crutches  for 
eight  months,  when  he  came  for  treatment.  There 
was  no  flexibility  of  the  ankle,  which  was  very  tender 
and  swollen.  After  six  weeks'  treatment  once  a  day 
the  patient  was  cured. 

Case  IT. — A  young  lady  had  come  to  Washington 
to  attend  the  inauguration  of  one  of  the  Presidents. 


116  PRACTICAL   MASSAGE. 

Three  weeks  before,  she  shpped  on  the  icy  pavement 
and  sprained  her  right  ankle.  She  was  laid  up,  and  all 
sorts  of  liniments,  etc.,  were  prescribed  by  her  physi- 
cian. After  ten  days  he  told  her  that  there  was  noth- 
ing more  to  do  but  to  keep  quiet  for  two  or  three 
months,  when  she  probably  would  be  well.  At  this 
point  I  was  called  in,  and  the  young  lady  told  m:e,  with 
tears  in  her  eyes,  why  slie  had  come  to  the  city,  and 
that  now  she  was  told  that  she  would  have  to  be  cjuiet 
in  her  room  for  months,  and  she  implored  me  to  do 
my  best.  The  ankle  was  still  black  and  blue  and  very 
m;uch  swollen,  and  the  pain  did  not  allow  of  touching 
the  parts.  After  the  examination  she  was  informed 
that  she  would  pro1>ably  be  well  in  ten  days  if  treat- 
ment was  applied  twice  a  day.  To  this  she  was  only 
too  glad  to  consent. 

The  treatment  was  given  twice  that  day.  The  next 
day  the  most  of  the  discoloration  had  disappeared,  and 
now  she  was  told  to  walk  a  little  at  a  time  in  her  room. 
The  improvement  was  remarkable  from  day  to  day. 
The  ninth  day  after,  the  seventeenth  sitting,  she  was 
cured,  and  went  to  the  inauguration  ball  on  the  tenth 
day. 

She  had  no  relapse. 

Case  III. — About  two  years  ago  one  of  my  assist- 
ants sprained  his  left  ankle  in  a  gymnasium.  He  was 
brought  home  by  his  friends  and  told  to  be  quiet  in 
bed.  He  kept  on  all  night  bathing  the  leg  with  hot 
and  cold  water,  and  came  next  mo'ming  to>  the  Insti- 
tute.    The  joint  was  slightly  dislocated,  the  foot  was 


SPR.\IXS,  HYDRARTHRUS,  ETC.  117 

turned  upward  and  inward,  and  twice  as  large  as  usual. 
The  patient  was  a  strong  young  man,  so  that  I  at  once 
went  to  work  and  succeeded  in  getting  the  joint 
straight,  after  which  a  full  treatment  was  applied. 

.Vfter  four  days'  treatment,  twice  a  day,  the  young 
man  was  well. 

Prof.  Dr.  J,  Nicolaysen,  of  Christiania  (in  Norsk 
Mag.  for  La-gczndenskab,  1874),  communicates  the 
following  case  of  hydrartJints  (  water  on  the  knee)  : — 

"A  man,  32  years  old,  had  suffered  from  hydrar- 
tlirus  for  six  and  one-half  years.  Repeated  punctures 
and  evacuation  had  ahvays  been  follow^ed  by  a  re- 
accumulation  of  the  fluid. 

"Massage  was  used  for  several  months,  and  the 
patient  returned  to  his  work.     There  was  no  relapse." 

Another  gentleman,  26  years  old,  had  suffered  from 
hydrarthrus  for  two  months,  when  he  came  to  the 
same  professor,  who  sent  him  toi  me,  at  that  time  in 
Norway. 

After  two  w'eeks'  treatment  the  collection  of  fluid 
in  the  knee-joint  disappeared,  but  the  swelling  of  the 
capsule  continued. 

After  five  weeks'  treatment  the  patient  was  well. 

AMienever  massage  is  applied  to  a  leg  after  an  acci- 
dent, it  is  best  to  begin  with  vigorous  centripetal  strok- 
iugs  at  the  inside  of  the  thigh;  or  if  it)  be  the  arm. 
make  the  same  kind  of  strokings  on  the  inside  of  the 
upper  arm,  as  this  will,  quicker  than  any  other  manipu- 
lation, produce  absorption  through  the  big  veins  from 
the  diseased  part. 


118  PRACTICAL   MASSAGE. 

I  have  always  found  that  the  quickest  way  to  cure 
sprains  or  bruises  is  to  bathe  with  hot  water  immedi- 
ately after  the  accident  for  half  an  hour  or  more,  and 
then  apply  the  massage  oboz'e  the  sprain,  until  it  will 
allow  of  being  touched  with  gentle  strokings,  which 
gradually  should  be  increased  in  force ;  then  a  circular 
kneading  on  and  around  the  sick  parts  with  the  fingers 
of  one  hand,  while  the  other  hand  is  continuosly  strok- 
ing upward. 

Even  in  fractures  it  will  be  of  great  value  to  use 
the  hot  water,  and  centripetal  strokings  above  the  frac- 
tured parts,  which  will  reduce  the  swellings  and  enable 
the  surgeon  to  set  the  bones  with  more  accuracy. 


CHAPTER  XVI. 

Flat-foot. 

("Morbid  condition  of  foot  in  ivhich  the 
arch  is  destroyed." ) 

This  troii])le  has  grown  very  marked  the  last 
twenty-odd  years,  iuid  many  theories  are  advanced,  and 
espe,cially  have  the  orthopedic  surgeons  insisted  that 
the  habit  of  standing  and  walking  with  the  toes  turned 
out  is  the  chief  cause  of  this  malady. 

In  this  I  cannot  agree;  and  although  I  am  not  a 
surgeon,  I  still  believe  I  have  some  right  to  my  opin- 
ion— having  taught  gymnastics  to  hundreds  of  thou- 
sands, boys,  girls,  and  adults,  and  treated  many  hun- 
dreds in  the  last  forty  years. 

The  surgeon  says :  "These  patients  come  to  me 
invariably  with  the  feet  turned  abnormally  out;  they 
are  fiat-footed,  and  I  tell  them  to  practice  standing 
and  walking  with  their  feet  parallel — even  turned 
inward — which  relieves  them  and  helps  to  cure  them." 

Very  well ;  but  supposing  a  physician  orders  a  pa- 
tient to  take  stiychnine,  are  we  tO'  understand  that  he 
is  tO'  do  so  all  his  life,  or  even  that  other  persons  must 
take  it  because  it  cures  in  some  cases? 

My  theory  is,  that  it  was  the  broken-down  arch 
which  made  the  foot  turn  abnormally  outwird,  not 
the  reverse. 

(119) 


120  PIL\CTICAL   MASSAGE. 

Who  are  those  who  mostly  suffer  from  fiat-foot? 
They  are  saleswomen  and  nurses;  and  wdiy?  Because 
they  have  tO'  be  on  their  feet  all  day  (most  frequently 
in  poorly  fitting-  shoes)  ;  their  feet  tire,  and  they  begin 
to  walk  with  stiff  ankles^ — no-  foot  action ;  consequently 
all  the  muscles  are  weakened  and  cannot  do  their 
work;  they  "give,"  and  the  pressure  on  the  arch  of 
the  foot  being  nO'W  unbearable,  the  foot  gradually 
turns  O'Utward.  And  this  is  what  the  surgeon  sees; 
but  he  did  not  see  this  patient  before  she  was  taken  ilk 
when  her  foot  in  ninety-nine  out  of  a  hundred  cases 
was  normally  turned. 

Of  course,  if  it  was  an  abduction  of  the  foot  in  the 
ankle,  which  made  us  turn  our  feet  outward  in  stand- 
ing, I  would- say  "the  surgeon  is  right;"  but  the  gym- 
nastic standing  position  with  the  toes  turned  out  is 
done  by  a  rotation  of  the  thigh  at  the  hip^joint,  and 
we  insist  that  the  toes  shall  always  be  in  line  with  the 
patella,  and  there  is  no^  danger  for  the  arch  of  the  foot 
as  long  as  the  muscles  are  kept  strong  and  active. 

There  is  another  cause  why  women  suffer  so-  much 
more  with  the  malady  than  men,  namely,  because  they 
are  naturally  "knock-kneed,"  this  puts  a  heavier  bur- 
den on  the  arch  of  the  foot. 

If  people  would  be  careful  about  always  keeping 
the  toes  in  line  with  the  knee  in  walking  and  standing, 
in  g\Tnnastics  and  dancing,  and  exercise  their  ankles, 
as  well  as  having  shoes  comfortable  and  well-fitting, 
we  should  see  much  less  of  these  troubles. 

The  crusade  which  has  been  going  on  for  several 


FLAT-FOOT.  121 

years  and  whicli  has  resulted  in  nnsi^^litly.  awkward 
p()siti(Mis  of  the  feet  in  many  sehouls,  in  this  eountry 
will  ultimately  lead  to  a  nation  of  l)ow-lei;"j:;"e(l  men 
and  wonren. 

( )ne  argiiment  nften  used  is,  that  the  Indians  st.and 
a.nd  walk  with  toes  strait;ht  ahead — iJicrcfovc  it  is 
natural! 

A\'ell,  the  mountaineers  of  Norway  walk  with  their 
feet  abnormally  out  to  Ijetter  climl>  the  mountains. 

In  either  case  it  is  the  condition  which  has  made 
them  as  they  are. 

We  have  alsoi  been  told  that  our  "forefather."  the 
"monkey,"  keeps  his  feet  (rather  hands,  th.ough ) 
turned  inward — that  it  is  natural  and  we  must  do  the 
same. 

There  are  very  few  people  nowadays  who  care  to 
"ape"  the  monkey;  we  will  rather  keep  a  big  distance. 

Sometimes  we  find  some  girls  in  the  gymnasiums 
suffering  with  "flat-foot,"  and  it  is  rather  strange  that 
there  are  not  many  more  of  them.  These  voung  ladies 
ha^•e  for  many  years  been  wearing  hig'h  shoes  with 
high  heels,  and  now^  they  are  suddenlv  forced  to  wear 
gym.  shoes  without  any  heels  for  three  to  five  hours 
a  day.  No  wonder  that  they  suft'er.  These  people 
shonld  be  given  small  heels  inside  their  shoes. 

I  have  had  great  success  in  treating  /7o/-/oo/  with 
massage  and  a  few  simple  exercises,  as  follows : — 

1.  Centripetal   stroking  of  foot  and   leg  to   knee. 

2.  IMuscle  kneading  of  foot  and  up  the  inside  of 
the  leg ;  also  percussion. 


122  PRACTICAL   MASSAGE. 

3.  Foot  rotation. 

4.  Foot  flexion  inward  and  upward,  with  resist- 
ance. 

5.  Foot  extension  wnth  resistance. 

6.  Again  muscle  kneading,  percussion,  and 
stroking. 

This  ought  to  be  given  every  day,  or  at  least  every 
other  day ;  and  the  patient  should  take  some  exercises 
at  home  morning  and  night : — 

1.  Sit  and  rotate  her  foot  actively. 

2.  Turn  the  foot  inward  and  upward  and  resist 
with  her  hand. 

3.  Stand  and  raise  on  tip-toes  and  at  the  same  time 
turn  toes  in  and  heels  out. 

4.  Deep  knee  bending. 

5.  Sit  or  stand  and  try  to  pick  up  a  marble  with 
the  toes. 

6.  Centripetal  stroking  of  foot  and  leg. 


CHAPTr:R  XVII. 

General  ]\Iassage 

has  within  the  last  thirty  years  become  of  such  great 
importance  in  the  treatment  of  many  kinds  of  ills  that 
I  ^\•ish  to  take  it  up  as  a  special  branch  of  massage. 
Thirty  years  ago  it  was  hardly  known  in  Europe,  and 
even  to-day  we  hear  the  young  masseuses,  who  have 
recently  come  over  from  Sweden,  saying  that  they 
don't  like  to  give  "general"  massage  and  don't  care  for 
such  cases. 

The  real  reason  is  that;  they  have  not  learned  that 
kind  of  massage  in  Sweden.  They  have  had  a  thor- 
ough course  in  medical  gymnastics  and  local  massage, 
but  not  in  general  massage,  and  because  the  American 
people  have  come  to  look  to  every  Swede  as  a  natural 
masseuse,  \\hich,  however,  is  a  great  mistake,  these 
inexperienced  young  ladies  put  on  the  air  of  authority 
and  knowledge  and  scorn  the  idea  of  giving  general 
massage. 

My  advice  to  all  newcomers  is  to  learn  general 
massage  as  quickly  as  possible,  and  also  to  learn  how 
American  patients  are  treated,  and  even  to  take  a  sh(^rt 
course  of  study  here  before  they  visit  the  physicians 
with  their  cards. 

There  was  a  time  when  "graduated  from  Sweden" 
was  the  best  possible  recommendation  on  a  card,  but 

(123) 


124  PRACTICAL   MASSAGE. 

that  time  has  passed,  since  we  have  just  as  good  schools 
right  here,  where  the  theory  is  broader  and  the  practi- 
cal work  even  more  practical. 

It  is  true  that  general  massage  is  often  used  when 
medical  gymnastics  with  some  local  massage  would  do 
more  good.  But  when  the  customer  (I  can  hardly  call 
her  patient)  prefers  the  "massage"  as  a  mode  of  exer- 
cise which  she  enjoys  and  therefore  also  finds  it  bene- 
ficial, I  think  the  masseuses  ought  to  be  thankful  that 
there  are  so  many  well-to-do'  women  who  are  willing 
to  employ  them. 

General  massag'e  is  of  great  benefit  in  cases  where 
the  patient  is  unable  to  sit  up,  either  from  sickness  or 
weakness,  or  overtired  mentally  and  physicall)^;  and  it 
certainly  also  is  a  great  remedy  to  "toaie  up"  the  sys- 
tem and  to  help  the  society  lady  to  keep  up  her  social 
duties. 

Dr.  J.  Schreiber  says  :  "In  the  treatment  of  neuras- 
thenia and  its  allied  affections,  hysteria  and  hypochon- 
dria, we  seek  to  attain  a  threefold  end.  First,  to  re- 
generate the  mass  of  blood  as  a  whole ;  secondly,  to 
combat  indi\idual  symptoms;  and,  thirdly,  to  favor- 
ably influence  the  mental  state. 

"Beard,  who  claims  for  neurasthenia  that  it  is  a  new 
and  especially  American  disease,  considers  massage 
treatment  as  not  only  essential,  but  absolutely  indis- 
pensable, for  those  casesi  whicli  it  seems  advisable  to 
confine  to  bed." 

Dr.  Vieh  Mitchell  says,  in  his  "Fat  and  Blood," 
that  he  has  applied  massage  to  deprive  rest  of  its  evils. 


GF.XKRAL    MASSAGE.  125 

Amid  all  the  numerous  mdrhid  manifestations  ac- 
companying neurasthenia,  hyperesthesia  and  muscular 
weakness  are  probaly  the  most  prominent,  so  that 
Arndt  has  declared  the  nature  of  the  disease  to  con- 
sist in  increased  irritability,  with  rapid  tendency  to 
fatigue,  especinlly  of  the  muscular  system. 

In  neurasthenia,  all  the  morbid  processes  occurring 
in  the  muscles  are  more  rapidly  influenced  by  move- 
ment treatment  than  by  either  hydro-  or  electro-  ther- 
apy. Of  all  symptoms,  the  various  hyperesthesias 
(excessive  sensibility)  most  frequently  engage  the 
physician's  attention. 

These  are  generally  regarded  by  the  friends  as 
founded  either  on  exaggeration  or  upon  affectation. 
Patients  complain  of  muscular  pain,  especially  in  the 
extremities  and  back,  and  of  pains  along  the  spinal 
column,  the  latter  being,  indeed,  considered  quite  char- 
acteristic of  the  disease  ("spinal  irritation"). 

Besides  these,  neurasthenics  suft'er  from  the  great- 
est variety  of  symptoms  referable  to  the  brain,  as  head- 
ache, and  a  feeling  of  weight  or  constriction  in  the 
head,  eye,  and  ear,  photopsia  (sensation  of  light), 
scotoma  (dark  spots  in  the  vision),  roaring  and  ring- 
ing in  the  ears,  hypersensitiveness  to  odors,  and  other 
similar  idiosyncrasies.  Or  there  may  be  liability  to 
sudden  changes  of  temper,  or  to  depression  and  sad- 
ness, or  dizziness  or  insomnia  may  exist.  Indeed,  the 
large  number  of  various  feelings  of  apprehension  ex- 
perienced in  neurasthenia  has  been  the  occasion  for 
the'manufacture,  bv  various  authors,  of  anv  number  of 


126  PRACTICAL   MASSAGE. 

"phobias.".  The  restlessness  sO'  often  seen  in  these- 
patients  is  caused  by  the  pains  occurring  in  various 
muscle  groups. 

The  "general  massage"  of  the  whole  body  will  be 
found  the  most  effectual  in  banishing  the  various  anes- 
thesias and  hyperesthesias,  while  passive  rotation,  flex- 
ion, and  extension  cause  a  stretching  of  the  nerves 
contained  within  the  muscles,  which  reacts  most  favor- 
ably upon  the  mental  state. 

Prescription  I. 

1.  Legs — centripetal  stroking,  kneading,  and  circu- 
lar friction. 

2.  Arms — centripetal  stroking,  kneading,  and  cir- 
cular friction, 

3.  Chest  kneading  and  friction. 

4.  Stomach  kneading  and  friction. 

5.  Back  kneading  and  friction, 

6.  Head  friction. 

If  the  patient  has  high  blood-pressure,  begin  with 
chest  and  stomach ;  then  legs,  arms,  back,  and  head. 

This  treatment,  should  be  applied  daily,  and  even 
twice  a  day,  until  the  patient  has  gained  some  strength, 
\\'hen  it  will  be  advisable  to  increase  the  treatment. 

In  order  to  give  a  good  treatment  the  operator 
should  be  of  a  good  disposition  and  cheerful,  neat,  and 
healthy;  finger-nails  fairly  short  and  well  taken  care 
of.  First,  see  that  the  patient  is  in  a  coirrfortable  bed, 
preferably  a  single  bed  or  a  couch ;  then  gO'  to  the  bath- 


GENERAL   MASSAGE.  127 

room  and  wash  the  hands  and  bring  a  towel  with  you 
to  the  patient's  room,  sit  down  l>esi(le  the  bed  with  the 
towel  in  your  lap,  and  let  the  patient's  foot  rest  on  it 
while  you  api)ly  the  massage  up  to  the  knee.  Now  put 
the  foot  back  in  bed  and  treat  the  rest  of  the  limb — 
from  the  knee  to  the  hi^) — while  it  is  lying  in  Ijed.  A 
good  masseur  can  apply  this  treatment  on  the  bare 
skin  without  exposing  the  limb.  Then  move  over  to 
the  other  side  and  massage  that  leg.  Next  take  the 
arm  on  the  same  side  and  rest  the  hand  in  your  lap 
while  you  work  the  whole  aruT  and  shoulder.  Again 
move  your  chair  to  the  first  side  and  treat  that  ami. 
Then  the  chest  and  abdomen,  and  help  the  patient  to 
turn  over,  face  down,  the  chin  resting  on  the  hands, 
Avhile  you  treat  the  back.  Again  go  and  wash  your 
hands  l^efore  you  apply  head  friction  and  strokings 
do'wn  the  throat. 

Remember  that  the  more  comfortable  the  operator 
is  the  better  treatment  is  he,  or  she,  able  tO'  give.  Do 
not  stand  up  more  than  absolutely  necessary,  or  you 
will  soon  feel  that  you  have  a  back. 

The  idea  that  a  masseur  or  masseuse  must  be  big 
and  very  strong  is  a  mistake.  If  they  only  know  Aotc 
to  do  it  and  how  not  to  exhaust  themselves,  but  1>e 
calm  and  quiet,  they  will  often  do  much  better  than 
their  big  sister ;  of  course,  some  strength  in  arms  and 
hands  is  needed,  but  that  will  soon  come  with  the 
practice. 

In  massage  treatment  it  is  very  essential  that  the 
patient  take  "a  liking"  to  the  operator  and  her  treat- 


128  PRACTICAL   MASSAGE. 

nient,  as  that  will  further  the  impro'vement  very  much. 
On  the  other  hand,  if  the  patient  docs  not  like  the 
operator,  her  mind  will  work  ag-ainst  the  treatment, 
and  often  "the  massage"  has  been  said  to  be  a  failure, 
^^'hile  it  really  was  the  person  giving  it  who  was 
unsuccessful. 

Further,  remember  that  there  are  many  kinds  of 
manipulations  and-  different  movements,  and  if  any  of 
the  kinds  you  are  giving-  seenrs  to  disagree  with  the 
]>atient,  or  she  dislikes  it,  change  it  with  some  other 
which  mav  have  about  the  same  effect.  In  general 
massage  it  is  not  advisable  to  force  unpleasant  move- 
ments on  the  patient.  Neither  is  it  necessary  to  use 
any  kind  oi  ointment ;  it  is  even  better  not  to  use  it, 
unless  the  physician  in  charge  prescribes  it  for  some 
curative  reasons.  As  a  rule,  ointment  should  only  be 
used  in  local  massage  where  vigorous  strokings  are 
necessary,  so  as  not  to  take  the  skin  off. 

Prescription  No.  i  is  to  be  given  to^  all  new  patients 
and  those  who  are  weak  and  delicate,  but  the  treatment 
should  be  gradually  increased  in  strength  and  in  num- 
ber of  moA'ements.  After  a  while — four  to  eight  days 
— add  "thigh  rotation"  after  the  first  manipulation;  in 
a  few  days  more  give  "arm  rotation"  after  No.  2 ; 
then  give  "foot  rotation"  single,  and  "forearm  rota- 
tion," and  "hand  rotation." 

When  the  patient  has  had  about  two  or  three 
weeks'  treatment,  use: — 


GENERAL   MASSAGE.  129 

Prescription  II. 

1.  Leg's — centripetal  massage. 

2.  Thigh  rotation — passive. 

3.  Foot  rotation — single — passive. 

4.  Legs — nerve  compression,  muscle  rolling,  slap- 
ping, and  friction. 

5.  Amis — centripetal  massage. 

6.  Ann  rotation — passive. 

7.  Forearm  and  hand  rotation — passive. 

8.  Arms — nerve  compression,  muscle  rolling,  slap- 
ping, aud  friction. 

9.  Chest' — kneading,  slapping,  vibration,  and 
friction. 

10.  Stomach' — kneading  and  friction. 

1 1 .  Back — massage. 

12.  Head  friction  (or  if  needed — head  n?assage). 
Keep  this  up  for  some  time,  then  add  "leg  flexioo 

and  extension,"  and  "upward  knee,  traction"  after  No. 
2:  and  later  "ann  flexion  and  extension"  (resistive) 
and  forearm  rotation ;  and  still  later  "chest  lifting  and 
vibration"  after  No.  8. 

\\'hile  we  add  more  and  more  movements  we  grad- 
ually shorten  the  length  of  the  centripetal  massage,  till 
we  finally  have  the  patient  up  and  out  of  b^d  and  stop 
the  centripetal  massage  entirely. 

Tn  the  l>eginning  centripetal  massage  is  most  effec- 
tual, liecause  there  is  alwavs  a  great  deal  of  waste 


1  Chest  and  stomach  first  in  cases  of  high  blood-pressure. 

9 


130  PRACTICAL   MASSAGE. 

matter  which  must  be  absorbed  quickly ;  but  after  some 
time  the  other  manipulations  and  movements  are  more 
necessary  and  will  dO'  more  good.  And  it  is  a  great 
mistake  to  keep  a  patient  with  neurasthenia  or  ner- 
vous prostration  on  the  same  kind  of  massage  for 
weeks  and  months.  Their  treatment  should  be  pro- 
gressive from,  week  to  week,  and  as  soon  as  the  patient 
is  able  to  be  up  and  out  of  bed  the  exercises  should 
be  changed  to 

Prescription  III. 

1.  Forward   arm   rotation — sitting — passive. 

2.  Foot  rotation — double — reclining — passive. 

3.  Trunk  rotation — astride  sitting — passive. 

4.  Vertical  arm  flexion  and   extension — sitting — 
resistive. 

5.  Leg  flexion  and  extension — reclining — resistive. 

6.  Chest  slapping — standing — passive. 

7.  Arms^ — nerve  compression,  rolling,  slapping,  and 
friction. 

8.  Legs — the  same — reclining. 

9.  Stomach-    kneading,    vibration,    and    friction — 
reclining. 

10.  Back  percussion — standing. 

11.  Head  massage^ — sitting. 

"High  Blood-pressurf/''  and  "Arteriosclerosis." 

In  treating  persons  with  either  of  these  maladies 
Dr.  H.  V.  Barclay,  of  New  York,  has  for  some  years 


2  Stomach  first  in  case  of  high  blood-pressure. 


HIGH   BLOOD-PRESSURE.  131 

applied  a  sort  of  circular  kneading  with  the  palm  and 
"heel"  of  the  hand  oil  ivcll-strctchcd  muscles;  and  he 
has  had  great  success. 

Personally  I  have  practised  this  method  more  or 
less  the  last  few  years  with  satisfaction;  and  I  have 
also  had  an  exi>ert  physician  to  take  the  "blood-pres- 
sure" of  some  of  my  patients  before  and  after  treat- 
ment, with  the  average  result  of  a  decrease  of  9  mm. 

The  modus  operandi  is  as  follows:  The  patient 
lying  straight  on  his  back,  with  a  small  pillow  under 
the  shoulder-blades,  head  and  shoulders  well  back  on 
the  bed,  so  as  to  keep  the  anterior  muscles  of  the  body 
on  a  good  passive  "stretch." 

Now  give  a  few  centripetal  strokings  of  the  throat 
and  light  circular  kneading  with  the  whole  hand  on 
the  pectoral  muscles,  and  some  strokings  from,  the 
middle  line  of  abdomen  outward.  Next,  have  the  pa- 
tient lying  on  his  side  (say  left  side),  pull  right  arm 
backward  and  perfectly  straight  at  the  elbow,  bend 
hand  backward ;  in  this  position  knead  front  of 
shoulder  and  all  the  flexor  muscles  of  the  arm  with 
the  palm,  or  "heel,"  of  your  hand,  beginning  at  the 
shoulder  and  gradually  work  downward,  taking  care 
not  to  "stroke"  against  the  venous  current. 

Now  bend  the  ann  over  and  in  front  of  the  pa- 
tient's head  to  put  all  the  extensor  muscles  on  the 
stretch  and  knead,  beginning  at  the  cendcal  and  dorsal 
spine  and  work  toward  the  hand ;  finally  raise  the  arm 
well  over  the  head  and  work  down  the  latissimus  dorsi. 

Bend  the  right  knee  well  up  against  the  patient's 


132  PR.\CTICAL   MASSAGE. 

body  and  knead  the  buttocks  and  back  of  the  thigh; 
then  pull  the  leg  backward  and  knead  front  of  the 
thigh ;  bend  the  knee  and  knead  front  of  the  leg ; 
straighten  the  leg  and  bend  the  foot  and  knead  the 
calf. 

When  both  sides  have  been  manipulated,  have  the 
patient  on  his  stomach  and  give  a  few  frictions  down 
the  back. 

The  whole  procedure  should  not  occupy  more  than 
fifteen  to  twenty  minutes. 


CHAPTER  XVIII. 
Hysteria  and  Hypochondria. 

These  affections  are,  according  to  Arndt,  quite 
impossible  to  separate  from  neurasthenia.  He  con- 
sidered the  numerous  temis  of  different  authors — such 
as  spinal  neurosis,  spasnTophilia,  spinal  weakness  or 
irritability,  neurosism,,  erethism,  and  others — to  be  but 
different  names  for  one  and  the  same  condition.  The 
different  writers  seem,  however,  tO'  be  of  the  opinion 
that  it  is  impossible  to  permanently  cure  this  condi- 
tion, and  that  no  medicaments  exist  capable  of  per- 
manently allaying  the  irritability  of  the  hyperesthetic 
nerves. 

Nevertheless,  a  daily  course  of  carefullly  system- 
atized exercises  will  always  be  of  great  value  to  these 
patients.  Several  of  the  active  exercises-  will  be  good. 
When  the  masseur  can  get  the  hysteric  woman  to 
work  hard  and  to  enjoy  the  exercises,  he  will  be  able 
by  moral  strength  of  character  tO'  effect  a  great  change 
in  her  mind,  and  a  steady  iuTprovement,  although  slow, 
may  be  looked  for. 

It  is  the  same  with  the  hypochondriac  man.  Give 
him  some  hard  work  and  try  to  gain  his  confidence  and 
also  tO'  get  his  mind  away  from  himself,  and  the  mas- 
seur will  accomr)li=:h  wonders.  But,  of  course,  these 
are  tryins-  cases  which  require  a  good  deal  of  patience 
and  tact  to  be  able  tO'  do'  anjrthing  with  them. 

C133) 


134      '  PRACTICAL   MASSAGE. 

The  prescription  of  exercises  should  be  made  with 
special  attention  to  the  ills  complained  of  and  a  gen- 
eral exercise  for  muscles  and  nerves. 

Chlorosis  and  Anemia. 

The  character  of  these  diseases  is  weakness,  there- 
fore it  may  seem  strange  tOi  treat  them  with  exercises. 
To  apply  fatiguing  movements  would  also  be  as  absurd 
as  to  prescribe  weakening  medicines,  but  by  stimu- 
lating and  strengthening  movements  re-establishment 
may  be  accomplished. 

The  muscles  being  the  chief  site  of  chemical  change 
occurring  in  the  body,  stimulating  and  increasing  their 
action  leads  to  increased  oxygenation  of  the  blood ;  to 
greater  combustion  oi  oxygen  and  elimination  of  car- 
bonic acid :  to  increased  metabolism  and  consequently 
tO'  greater  desire  for  food  and  tO'  better  digestion ;  to 
production  of  more  and  better  blood;  to  improved 
nourishment  of  the  nervous  system: ;  tO'  an  increase,  both 
in  number  and  strength,  of  the  mnscle-fibers ;  to  the 
endowment  of  the  whole  body  with  vigor  and  elasticity, 
and  to  a  consequent  revival  of  all  the  mental  faculties. 

In  dilorosis  and  anemia  the  blood-vessels  are  both 
thin-walled  and  of  narrow  caliber;  therefore,  active  and 
resistive  movements  should  be  used  which  stimulate 
cardiac  activity  and  increase  the  blood-pressure.  The 
augmented  hemic  oxygenation  thus  brought  about 
leads  both  to  an  increase  in  the  number  of  red  corpus- 
cles as  well  as  of  the  amount  of  hemo'srlobin  contained 


CHLOROSIS   AND   ANEMIA.  135 

in  each.  At  first,  owing  to  the  general  lassitude  from 
which  chlorotics  suffer,  the  movements  will  have  to  l>e 
of  a  very  gentle  nature. 

Although  there  may  be  a  little  difference  in  the 
treatment  of  two  different  persons,  it  should  always  be 
directed  so  as  to  restore  the  digestion,  circulation  and 
respiration. 

In  the  first  two  or  three  weeks  the  following  pre- 
scription would  be  most  acceptable : — 

Prescription  I. 

1.  Shoulder  rotation  and  chest  lifting — sitting. 

2.  Foot  rotation — double — reclining. 

3.  Stomach  vibration — reclining — knees  bent. 

4.  Forward  arm  rotation — sitting. 

5.  Trunk  rotation — astride — sitting. 

6.  Knee  flexion  and  extension — sitting — resistive. 

7.  Stomach  friction — lying. 

8.  Back  percussion  and  friction. 

The  first  movement  is  a  respiratory  one;  the  chest 
is  expanded,  the  inspiration  becomes  deeper  and  is  fol- 
lowed by  a  stronger  expiration.  Thus  a  greater 
amount  of  o^xygen  is  taken  and  waste  matter  given  off. 
This  must  stimulate  the  functions  of  the  organs  and 
thus  accelerate  the  process  of  renewal  and  an  exchange 
of  material  in  all  parts  of  the  body. 

The  second  movement  equalizes  the  circulation  by 
increasing  the  flow  of  blood  tO'  the  feet. 

The  third  movement  has  a  direct  effect  on  the  stom- 
ach, and  will  improve  the  appetite  and  the  digestion. 


136  PRACTICAL   MASSAGE. 

The  fourth  movement  is  a  respiratory  one  and  has 
a  similar  effect  as  the  first  one. 

The  fifth  movement  brings  the  muscles  of  the  waist 
and  bowels  into  play,  and  acts  on  the  circulation,  espe- 
cially in  the  portal  system. 

The  sixth  movement  has  a  strengthening  effect  on 
the  flexors  and  extensors  of  the  legs  and  promotes  the 
circulation. 

The  seventh  movement  promotes  operations  of  the 
bowels. 

l"he  eighth  movement  has  a  stimulating  effect  on 
the  nerve-centers. 

When  the  prescription  has  been  applied  for  a  while, 
and  the  patient  has  improved  in  strength,  the  treat- 
ment may  be  changed  in  force,  but  according  tO'  the 
same  principle. 

Prescription  II. 

1.  Forward  trunk  flexion  and  extension — sitting — 
resistive. 

2.  Foot  flexion  and  extension — double^ — reclining 
— resistive. 

3.  Trunk  torsion — sitting — resistive. 

4.  Vertical  arm  flexion  and  extension — sitting — 
resistive. 

5.  Forward  trunk  elevation — lying — active. 

6.  Leg  flexion  and  extension — reclining — resistive. 

7.  Stomach  friction — lying. 

8.  Breech  beating — standing. 

9.  Back  percussion  and  friction  downward — stand- 
ing.. 


INSOMNIA.  137 

If  the  patient  is  very  weak  and  hardly  able  to  walk 
about,  she  should  lie  down  on  a  lounge  and  have  the 
foiiowmg  manipulations  applied  to  her: — 

1.  Back  percussion  and  friction  downward. 

2.  Foot  rotation — double. 

3.  Arm  vibration. 

4.  Leg  nerve  compression. 

5.  Stomach  vibration. 

6.  Breech  beating  and  vibration  at  the  end  of  the 
spine. 

7.  Leg  vibration. 

8.  Spinal  nerve  compression. 

g.  Head  percussion  and  friction. 

Insomnia. 

Of  the  numerous  cases  of  insomnia  which  have 
couTe  under  my  observation,  the  following-described 
one  was  considered  by  the  attending  physicians  to  be 
exceedingly  dangerous,  and  one  in  which  the  patient 
was  so  weak  and  irritable  that  the  greatest  care  and 
gentleness  were  imperative. 

On  one  occasion  I  was  called  to  see  a  gentleman, 
40  years  old,  who  had  been  without  sleep  for  three 
weeks.  He  was  very  weak  and'  complained  of  great 
pain  in  the  back,  legs,  and  wrists.  He  was.  very  ner- 
vous and  irritable,  and  had  no  appetite. 

The  first  two  days  only  the  following  movements 
were  applied : — 

I.  Arms — friction — downward. 


138  PRACTICAL   MASSAGE. 

2.  Legs — friction — downward. 

3.  Back  friction — downward. 

4.  Head  friction. 

The  patient  had  some  sleep  the  first  night,  which 
was  increased  a  httle  every  following  night. 

The  third  day  the  treatment  was  increased  as  fol- 
lows : — 

1.  Stomach  friction. 

2.  Arms — nerve  compression,  rolling,  and  friction. 

3.  Legs — nerve  compression,  rolling,  and  friction. 

4.  Chest  friction. 

5.  Back  kneading  and  friction. 

6.  Head  kneading  and  friction. 

The  force  of  the  manipulation  was  increased  a  little 
every  day. 

The  seventh  day  the  following  treatment  was  ap- 
plied : — 

1.  Stomach  kneading  and  friction. 

2.  Legs — thigh  rotation. 

3.  Arms — arm  rotation  and  hand  rotation, 

4.  Chest  lifting  and  vibration. 

5.  Chest  slapping,  kneading,  and  friction. 

6.  Arms — nerve  compression,  rolling,  and  friction. 

7.  Legs — nerve  compression,  rolling,  and  friction. 

8.  Back  kneading,  vibration,  percussion,  and  fric- 
tion. 

9.  Head  percussion,  kneading,  and  friction. 

After  two  weeks'  treatment  the  patient  slept  the 
whole  night,  and  he  did  not  complain  of  any  pains,  and 


INSOMNIA.  139 

accordingly   resistive   movements   were  added   to   the 
former  ones  in  tlie  following  manner: — 

1.  Stomach  kneading  and  friction, 

2.  Legs — fcxot   rotation — doiiI>le — passive. 

3.  Arms — rotation  and  hand  rotation — passive. 

4.  Chest  lifting  and  vibration. 

5.  Chest  slapping,  kneading,  and  friction. 

6.  Arms — flexion  and  extension — resistive. 

7.  Arms — nerve  compression,  rolling,  slapping,  and 
friction. 

8.  Legs — flexion  and  extension — resistive. 

9.  Legs — nen-e  compression,  rolling,  slapping,  and 
friction. 

10.  Back  kneading,  vibration,  percussion,  and  fric- 
tion. 

11.  Head  rotation — sitting. 

12.  Head  percussion,  kneading,  and  friction. 

One  month  after  the  treatment  began  the  patient 
was  well. 

It  is  astonishing  how  quickly  relief  and  sleep  can  be 
effected  to  seemingly  sleepless  patients  by  light  fric- 
tions d ozi'uzcard ,  and  also  by  long  and  deep  inhalations. 
Time  and  time  again  I  have  been  called  in  the  middle 
of  the  night  to  apply  such  treatment  to  men  of  high 
standing  and  great  mind.  Indeed,  during  my  practice 
in  Washington  I  frequently  had  to  shut  off  the  light 
in  the  W'hite  House,  telling  the  officers  at  the  door,  as 
I  left,  that  the  President  was  asleep. 


140  PRACTICAL   MASSAGE. 

Diabetes  Mellitus 

has  often  been  treated  with  massage  and  exercise.  It 
has  been  shown  that  a  large  percentage  of  these  cases 
occur  in  corpulent  individuals  belonging  tO'  the  richer 
classes  of  society,  and  that  an  inactive  mode  of  life, 
affording  but  little  bodily  exercise,  combined  with  ex- 
cesses in  diet,  are  favorable  predisposing  causes. 

Among  the  commonest  sympoms  are  muscular 
weakness  and  its  accompanying  fatigue,  due  to  the 
insufficient  nourishment  which  the  saccharine  blood 
affords  the  muscles. 

Cantani  holds  diabetes  to  be  due  to  a  metabolic 
anomaly,  in  which  both  the  sugar  ingested  and  that 
formed  in  the  body  from  albumins,  is  not  destroyed  as 
is  normally  the  case,  and  hence  reappears  in  the  urine. 
All  physiologists  agree  on  the  muscles  being  the  prin- 
cipal seat  of  metabolism,  and  Zimmer  reasons  as  fol- 
lows :  "Liver  and  muscle  both  contain  glycogen,  a  fer- 
ment, and  water — the  three  elements  necessary  for  the 
formation  of  sugar.  The  proportion  of  glycogen  and 
ferment  are  relatively  constant,  while  that  of  water  is 
variable.  If  the  amount  of  water  be  permanently  in- 
creased, a  continuous  fonnation  of  sugar  in  these 
organs  occurs,  and  diabetes  results. 

"Where  the  diabetes  is  of  hepatic  origin  the  liver 
will  be  in  a  state  of  constant  hyperemia." 

Active  exercise,  however,  causes  a  diminution  of 
the  amount  of  blood  in  all  internal  organs  through  de- 
termination to  the  muscles,  and  the  oxidative  processes 


DIABETES    MELLITUS.  141 

taking  place  in  the  latter  result  in  the  combustion  of 
niiicli  of  the  suiiar  contained  in  the  blood.  Thus  in. 
diabetics  who  indulge  in  little  or  no  exercise  accumu- 
lation of  sugar  necessarily  occurs. 

ZimnTer  is  convinced  that  persistent  exercise,  in- 
\olving  all  the  large  muscle  groups,  is  capal)le  of  en- 
tirely curing  hepatogenous  diabetes  in  many  cases,  and 
much  improving  the  condition  in  others. 

Prescription  I. 

1.  Back  percussion — standing. 

2.  Foot  rotation — double^ — reclining. 

3.  Horizontal  arm  t^exion  and  extension — sitting 
— resistive. 

4.  Forward  trtmk  flexion  and  extensioin — sitting — • 
resistive. 

5.  Leg  nerve  compression — reclining. 

6.  Arm  nerve  compression — sitting. 

7.  Leg  flexion  and  extension — reclining — resistive. 

8.  Vertical  arm  flexion  and  extension — sitting — 
resistive. 

9.  Stomach  vibration — reclining. 

10.  Leg  vibration — reclining. 

11.  Arm  vibration — sitting. 

When  the  patient  has  gained  some  strength  change 


to 


Prescription  II. 

I.   Horizontal  arm  separation  and  closing — sitting 
-resistive. 


142  PRACTICAL   MASSAGE. 

2.  Foot    flexion    and    extension — reclining — resis- 
tive. 

3.  Trunk  torsion — kneeling — resistive. 

4.  Backward  leg  traction — standing — resistive. 

5.  Chopping  movement — standing — active. 

6.  Harvesting  movement — standing — active. 

7.  Neck    flexion    and    extension — standing — resis- 
tive. 

8.  Bent-knee  separation  and  closing — reclining — 
resistive. 

9.  Lateral  arm  elevation  and  depression — standing 
— resistive. 

10.  Back  percussion — standing. 


CHAPTER  XIX. 

Local  Djskasi;s. — Diskasks  oi-  the  ]*>raix,  Spinal 
Cord,  and  Xi:r\e. 

congestion  of  the  i'.kain   (congestio  cerebralis). 

Severe  acute  congestion  of  the  brain  will  hardly 
be  favorable  to  movement  treatment,  but  milder  cases 
have  often  been  treated  with  success.  The  movements 
should  be  directed  so  as  to  drive  the  bloo<l  from  the 
brain,  therefore  movements  of  the  extremities  should 
be  applied.  If  the  patient  is  not  confined  to  bed  the 
following  prescriptioii  would  be  useful : — 

1.  Shoulder  rotation  and  chest  lifting — sitting. 

2.  Thigh  rotation — reclining. 

3.  Trunk  rotation — astride* — sitting. 

4.  Leg  flexion  and  extension — reclining — -resistive. 

5.  Neck  flexion  and  extension — standing — resis- 
tive. 

6.  Foot  rotation  and  flexion  and  extensioii — double 
— reclining. 

7.  Arm  rotation — single — sitting. 

8.  Breech  beating — standing. 

9.  Knee  flexion  and  extension — sitting — resistive. 

10.  Head  percussion,  vibration,  and  friction. 

11.  Forward  ami  rotation — sitting. 

(143) 


144  PRACTICAL  MASSAGE. 


ANEMIA   OF   THE   BRAIN, 


The  movements  in  these  cases  should  be  stimulat- 
ing and  strengthening. 

1.  Chest  Hfting  and  vibration — lying. 

2.  Leg  nerve  compression,  rolling,  slapping,  and 
friction. 

3.  Arm  compression,  rolling,  slapping,  and  friction. 

4.  Head  rotation — sitting. 

5.  Leg  vibration — lying. 

6.  Arm  vibration — sitting. 

7.  Stomach  friction  and  circular  kneading — lying. 

8.  Back  percussion  and  friction. 

9.  Head  percussion,  kneading,  vibration,  and  fric- 
tion. 

PARALYSIS    AS    A    RESULT    OF    APOPLEXY. 

The  treatment  here  is  to  avoid  new  attacks  as  well 
as  to  improve  the  patient's  condition,  and  foi-"  this  rea- 
son the  movements  should  not  only  be  applied  tO'  the 
paralyzed  arm  and  leg,  but  to  tlie  whole  body. 

The  following  illustration  of  this  mode  of  treat- 
ment gives  the  best  example  of  prescriptions  for  such 
patients : — 

.V  gentleman,  64  years  old,  was  stricken  with  apo- 
plexy, resulting  in  a  partial  paralysis  of  the  right  side. 
Forty-eight  hours  later  the  writer  was  called  in  by  his 
physician  to  try  the  massage  treatment.  The  patient 
was  at  this  time  still  unconscious. 


PARALYSIS.  145 

The  first  day  the  following-  movements  were  ap- 
plied very  gently: — 

1.  Right  ami  nerve  compression  and  friction. 

2.  Right  hand  ajidi  finger  rotation. 

3.  Right  leg  ner\-e  compression  and  friction. 

4.  Right  foot  rotation. 

5.  Right  leg  muscle  rolling  and  friction. 

6.  Right  arm  muscle  rolling  ajid  friction. 

The  next  day  the  patient  seemed  to  know  what  was 
going  on,  as  he  saw  the  operator  and  objected  to  have 
a  stranger  alx)iit  him.  Xe^•ertheJess,  by  kind  words 
and  cheerfulness,  he  consented  to  the  treatment.  There 
was  now  a  slight  movement  of  the  right  leg,  and  there 
was  applied,  in  addition  to  the  former  prescription : — 

Thigh  rotation  and  leg  flexion  and  extension,  pas- 
sive, to  the  right  leg. 

The  third  day  the  patient  was  glad  to  see  the  opera- 
tor and  delighted  to  show  him  his  improvement,  as  he 
now  was  able  to  draw  his  knee  up,  make  a.  slight  mo- 
tion of  the  foot,  and  of  the  arm. 

His  right  hand  and  fingers  were  swollen  and  pain- 
ful, and  he  could  not  see  with  his  right  eye,  and  he 
spoke  with  difficulty. 

Centripetal  stroking  and  k)ieadi}ig  was  first  applied 
to  the  right  fingers,  hand,  and  arm,  together  w'ith  the 
following  movements : — 

Right  hand  and  finger  rotation  and  flexion — pas- 
sive ; 

Right  arm  rotation  and  flexion — passive ' 

Centripetal  stroking  and  kneading  of  right  leg; 
10 


146  PRACTICAL   MASSAGE. 

Right  foot  rotation  and  flexion — passive; 

Thigii  rotation  and  leg"  flexion — both  legs — pas- 
sive; 

Both  arms — nerve  compression,  rolling,  and  fric- 
tion ; 

Both  legs — nerve  compression,  rolling  and  friction. 

The  fourth  day  no  treatment  was  given. 

The  fifth  day  considerable  improvement  was 
noticed  in  moving  both  the  arnT  and  leg ;  the  swelling 
and  pain  of  the  right  hand  were  veiy  much  less.  The 
same  movements  were  used  as  at  the  last  time. 

The  sixth  day  no  treatment  was  applied. 

The  se\"enth  day  the  iuTprovement  was  astonishing: 
the  swelling  of  the  right  hand  had  disappeared,  and 
the  patient  was  able  to 'take  me  by  the  hand  and  to 
move  his  foot  and  leg  at  will.  Prescription  was  then 
changed  to  the  following: — 

Chest  lifting  and  vibration; 

Thigh  rotation  of  both,  legs ; 

Right  arm  rotation; 

Foot  rotation,  double ; 

Right  hand  and  finger'  rotation  and  flexion — pas- 
sive ; 

Right  leg  nerve  compression,  rolling,  and  friction ; 

Right  ami  nerve  compressiou,  rolling,  and  friction ; 

Right  leg'  vibration ; 

Right  arm  vibration ; 

Back  kneading,  percussion,  and  friction. 

This  treatrrrent  was  repeated  the  eighth,  tenth,  and 
eleventh  days  after  the  first  visit. 


PARALYSIS.  147 

The  twelfth  day  the  patient  was  r.p  and  al)le  to 
\\alk  a  httle  in  his  rcx^ni,  and  the  follouini^-  prescrip- 
tion wa,s  then  given: — 

Shoulder  rotation  and  chest  Hftinir — sittinjr; 

Thigh  rotation,  both  legs — reclining; 

Right  arm  rotation — sitting; 

Right  foot  flexion  and  extension — sitting — resis- 
tive ; 

Right  ami  nen-e  compression,  rolling,  slapping,  and 
friction ; 

Right  leg  nerve  compression;  rolling,  slapping,  and 
friction; 

Right  arm  flexion  and  extension — resistive ; 

Forward  trunk  flexion-  and  extension — sitting — • 
resistive : 

Right  knee  flexion  and  extension — sitting — resis- 
tive; 

Right  arm  torsion — resistive; 

Right  arm  vibration — sitting; 

Trunk  rotation — astride  sitting — passive  ; 

Right  leg  torsion — resistive; 

Right  leg  vibration — reclining; 

Back  percussion  and  friction — standing; 

Head  kneading  and  friction. 

The  improvement  continued  from  day  to  day.  The 
eyesight  came  back,  the  speech  was  clearer,  and  the 
patient  gained  more  and  more  control  over  his  lim^bs. 
The  treatment  was  continued  every  other  day  for  two 
weeks  more,  when  the  patient  couTmenced  to  take  out- 
door walks. 


148  PRACTICAL   MASSAGE. 

The  fifth  week  only  two  treatments  were  applied 
and  then  entirely  discontinued,  the  patient  being  able 
to  walk  as  well  as  before  tha  stroke,  and  having  full 
use  of  his  arm. 

This  case  was  a  very  favorable,  one,  but  there  can 
be  no  doubt  that  the  movement  treatment  hastened  the 
improvement  considerably,  although  the  physician 
must  be  careful  not  to  apply  this  treatment  too:  soon, 
and  that  it  is  done  in  a  very  gentle  and  judicious 
manner. 

When  the  physician  does  not  feel  sure  that  the 
movements  will  have  a  good  effect  it  will  always  be 
best  to  wait  from  four  to  six  weeks  before  they  are 
resorted  to. 

Abdominal  massage  shoidd  not  be  applied  tq  these 
cases. 

Before  resistive  movemients  can  be  used  in  these 
cases  it  becomes  necessary  to-  apply  assistive  move- 
ments, then  actiz'e,  and  finally  resistizre,  which  fre- 
quently must  begin  with  "excentric"  exercise  before 
the  "concentric"  ones. 

For  instance,  in  case  of  the  right  arm^ — support  the 
elbow  and  tell  the  patient  tO'  bend  up  his  arm ;  he  can- 
not do  it — tell  him  again  and  again,  and  gradually 
push  his  arm'  up.  Now  tell  him  to;  extend  the  ann, 
which  probably  will  have  the  same  result,  and  you 
must  slowly  stretch  it  out  for  him.  Repeat  this  day 
after  day,  and  some  day  you  will  see  the  arm  begin  to 
move.  Then  encourage  the  patient  and  command  him 
to  reach  for  certain  objects — your  own  hand  in  dif- 


PARALYSIS.  149 

ferent  positions.  Gradually,  the  motor  nerve  centers 
are  jjeing  trained,  and  some  day  the  patient  is  able  to 
bend  and  stretch  his  arm  at  will,  althouj,di  it  may  be 
jerky  and  imevenly  and  with  very  little  strength.  Now 
begin  to  Ix^nd  the  ami,  while  you  tell  the  patient  to 
keep  it  straight ;  and  again  stretch  the  arm,  while  the 
patient  is  told  to  keep  it  l>ent. 

This  is  the  "excentric"  exercise,  which  will  gradu- 
ally make  the  muscles  stronger  and  able  to  bend  and 
stretch  "concentrically." 

This  mode  of  treatment  should  be  given  to  any 
part  where  it  seems  necessary — ann,  hand,  leg,  foot, 
etc. 

Besides  this,  be  cheerful  and  agreeable  to  the*  pa- 
tient; take  him  under  the  arm  and  walk  with  him, 
tiying  to  make  him  lift  both  his  legs  and  put  the  feet 
squarely  down  on  the  floor  without  hesitating.  Let 
him  try  to  hit  you  with  his  lame  fist  and,  grab  your 
arm,  and  also  tell  him  to  spread  out  his  fingers  a  cer- 
tain number  of  times,  several  times  daily,  etc. 

The  most  cases  of  paralysis  are  slow  to  recover, 
and  especially  is  the  hand,  as  a  rule,  far  l>ehind  the 
rest  of  the  body  in  becoming  well.  The  treatment  is 
agreeable  to  this  kind  of  patients  and  it  has  a  soothing 
and  cheerful  influence  on  them. 

Here  it  may  be  well  to  say  that  all  persons  w4io  have 
been  troubled  once  with  apoplexy  ought  never  to  stop 
taking  movement  treatment,  or  at  least  only  at  short 
intervals,  unless  they  have  plenty  of  other  healthful 
exercise,  as  it  is  the  best  means  to  prevent  another 
stroke. 


CHAPTER  XX. 

Local  Diseases  (Continued). 

CONGESTION    OF   THE   SPINE. 

This  disease  has  often  been  quickly  inTproved  by 
a  proper  treatment  of  derivative  movements,  which 
are  herein  set  forth  :— 

1.  Forward   arm   rotation — sitting — passive. 

2.  Foot  rotation,  double — reclining" — passive. 

3.  Vertical  arm  flexion  and  extension — sitting — 
resistive. 

4.  Leg  flexion  and  extension — reclining — resistive. 

5.  Trunk  torsion — astride  sitting — resistive. 

6.  Bent  knee  separation  and  closing — reclining — • 
resistive. 

7.  Breech  beating — standing — passive. 

8.  Knee  flexion  and  extension — sitting — resistive. 

9.  Stomach  friction— lying — passive. 

10.   Shoulder  rotation  and  chest  lifting— sitting. 

LOCOMOTOR    ATAXIA    ( TABES    DORSALIS). 

Dr.  Anders  Wide,  of  Stockholm,  says  in  his  book 
on  "Medical  and  Orthopedic  Gymnastics" : — 

"A  few  cases  of  tabes  dorsalis  are  treated  with 
gymnastics  every  year,  and  I  dare  assert  that  the  treat- 
ment has,  in  no  case,  been  without  result,  as  improve- 
(150) 


LOCOMOTOR   ATAXIA.  151 

nient  in  certain  symptoms  has  always  been  gained.  It 
is  specially  worthy  of  notice,  that  the  unsteadiness  in 
Avalking  and  the  inner  paresis  of  the  intestine  and 
bladder  can  be  diminished  or  even,  for  a  time,  totally 
disappear.  I  consider  it,  however,  to  be  my  duty  to 
point  out  here  that,  as  far  as  I  know,  no  return  to 
health  has  occurred  in  any  case  treated." 

Patients  with  this  disease  are  generally  more  hope- 
ful of  beneficial  results  than  physicians,  and  the 
knowledge  that  this  affection  frequently  comes  to  a 
standstill  and  improves,  and  that  in  some  few  instances 
recovery  has  taken  place,  ought  to  inspire  us  with 
more  hope  and  zeal  to  co-operate  with  the  sufferers. 

This  disease  is  characterized  clinically  by  want  of 
power  to  co-ordinate  voluntary  movements,  by  violent 
shooting  pains,  especially  in  the  legs ;  absence  of  knee- 
jerk,  atrophy  of  the  optic  nerve,  paresthesia  and  anes- 
thesia in  certain  parts,  dysuria,  and  functional  sexual 
disorders;  anatomically,  by  a  sclerosis  (hardening)  of 
the  posterior  columns  of  the  spinal  cord. 

The  treatment  prescribed  by  Dr.  ^^^ide  and  other 
Swedish  as  well  as  German  authorities  consists  merely 
of  passive  movements  and  massage,  and,  of  course, 
they  are  useful  and  even  necessary.  But  I  firmly  be- 
lieve, with  Dr.  H.  V,  Barclay,  of  New  York,  that  a 
thorough  course  of  educational  gymnastics  is  what  is 
mostly  needed  in  order  to  train  the  nerves  and  again 
awaken  the  activity  of  the  nerve-centers  and  make  the 
muscles  obey  the  will. 

Aly  mode  of  treating  these  cases  is  as  follows : — 


152  PRACTICAL   MASSAGE. 

1.  Back  percussion — standing. 

2.  Thigh  rotation — recHning. 

3.  Arm  rotation  and  forearm  rotation — sitting. 

4.  Trunk  rotation — astride  sitting. 

5.  Abdominal  massage — ^recHning. 

6.  Arms  nerve  compression,  muscle  rolling,  slap- 
ping and  friction — sitting. 

7.  Legs — the  same. 

While  the  patient  is  lying  down,  he  is  told  to 
move  his  legs  in  certain  directions. — pull  one  knee  up 
and  slowly  lower  it ;  bring-  the  leg  outward  and  back 
again;  cross  one  leg  over  the  other;  bring  one  foot 
toi  touch  the  other  leg,  or  knee,  etc.  At  first  these  are 
done  assisfk'cly  till  the  patient  gradually  is  able  to  do 
it  alone.  Later,  tlie  patient  stands  up  and  practises  dif- 
ferent exercises  at  my  comniand,  both  with  the  lower 
and  upper  extremities.  These  have  been  of  very  great 
value. 

This  is  what  has  been  called  the  "Frankel"  sys- 
tem, but  has  been  practised  by  myself  and  otliersi  long 
before  we  heard  of  Frankel. 

9.  Full  massage  of  the  back  and  buttocks. 

After  this  kind  O'f  treatment  has  been  used  for  some 
time — two  to  three  months — rcsistwe  exercises  may 
be  used,  always  taking  care  not  tO'  overtax  the  patients' 
strength,  as  they  are  generally  very  eager  toi  get  well 
and  apt  to  do  more  than  the}^  oug'ht  to  do. 

Cures  are  rare,  although  there  are  some  on  record, 
but  great  improvement  is  a  frequent  occurrence. 


CHAPTER  XXI. 

Infantile  Paralysis, 
roliomyelitis  anterior. 

This  dreaded  disease  is  nowadays  treated  almost 
entirely  with  massage.  At  least  our  greatest  medical 
experts  have  frequently  advised  patients  to  try  mas- 
sage as  the^  only  remedy  which  probably  will  restore 
the  functions  of  the  paralyzed  parts,  saying,  at  the 
same  time,  that  electricity  will  not  do-  it  and  m;ay  even 
do  harm. 

My  experience  with  these  cases  fully  agrees  with 
the  physicians — but  even  massage  may  do  harm,  if 
not  applied  carefully,  and  the  patient  constantly  warned 
not  to  overdo. 

^^"e  must  by  careful  examination  find  the  para- 
lyzed muscles  and  their  nerves,  and  apply  mild  muscle 
kneading  and  percussion  to  them.  Give'  passive  exer- 
cises— flexion,  extension,  abduction,  adduction,  and  ro- 
tations: stretch  contracted  muscles  and  ti*y  our  best  to 
make  the  weak,  paralyzed  muscles  contract  and  gradu- 
ally begin  to  work. 

Here  again  it  is  of  value  to  apply  assisfk'e  exer- 
cises and  make  the  patient  concentrate  his  will  on  the 
nmscles  to  be  used — always  taking  care  not  to  do  too 
much.     Of  course,  with  a  small  child  this  is  rather 

(153) 


154  PRACTICAL   MASSAGE. 

out  of  the  question ;  but  then  we  must  nivent  some 
exercise  which  the  child  wih  be  interested  in  doing, 
and  which  will  have  the  same  effect. 

When  we  know  the  exact  muscles  involved  we  can 
also  find  the  ner\Ts  and  apply  some  vibratory  pressure 
on  them  at  their  outlet  from  the  spinal  cord,  which 
will  have  a  stimulating  effect. 

Two  interesting  cases  of  mine  may  give  an  idea  of 
my  method  of  treatment : — 

I.  Some  years  ago  I  was  called  to  attend  to  a  girl 
Off  6  years  of  age;  she  had  never  been  able  to  stand 
on  her  feet ;  and  the  parents  asked  me  what  I  could 
do.  They  had  "been  going  to  a  doctor  for  electricity 
one  year,  to  an  osteopath  one  year,  and  a  lady  had 
applied  massage  every  day  for  one  year."  I  told  them 
that,  although  I  might  give  some  massage,  it  would 
probably  be  different  from  what  the  girl  had  been 
given,  and  that  I  would  rely  mostly  on  what  I  called 
educational  gymnastic  training. 

This  child  was  in  a  rather  feeble  and  nervous  con- 
dition ;  so  I  did  give  her  some  massage — nerve  com- 
pression and  frictions  of  amis  and  legs,  stomach  fric- 
tion and  circular  kneading  and  full  massage  of  the 
back.  Besides  this,  muscle  kneading  and  percussion  to 
the  weak  muscles  of  the  legs  and  passive  exercises, 
soon  followed  by  assistive,  and  before  one  month 
(treatment  three  times  a  week)  the  child  began  tO'  re- 
spond and  "jerkingly"  do  several  exercises.  Now  it 
was  to  make  the  exercise  even,  and  not  toi  allow  any 
movement  without  first  being  told,  as,  for  instance: 


INFANTILE  PARALYSIS.  155 

"Give  me  that  foot  in  my  hand,"  which  I  held  out- 
side. She  would  do  so,  l)ut  inimcdiatcly  tiy  to  pull  it 
back  again,  which  I  checked  by  saying  "Hold  it";  and 
after  a  short  rest,  "Now  pull  it  back,"  and  so'  on  in 
different  directions. 

After  three  months'  treatment  the  child  could 
stand  and,  holding  on  to  somebody,  take  a  few  steps. 
Then  they  went  away  for  the  summer,  which  was  good 
for  her  general  health.  In>  September  I  began  again, 
but  only  twice  a  week.  In  the  following  spring  one 
of  our  first  neurologists  saw  the  child  and  told  them 
to  continue  my  treatment,  but  every  day  and  not  twice 
a  week.  Another  summer  vacation  and,  we  continued 
treatment  three  times  a  week.  Now  the  child  stood 
up  and  I  taught  her  tcy  place  the  feet  in  different  di- 
rections and  before  the  next  summer  she  and  I  danced 
a  waltz  together.  Next  year,  treatment  twice  a 
week  and  she  walked  back  and  forth  tO'  school,  morn- 
ing and  afternoon;  the  abdominal  muscles  still  w^eak, 
so  her  gait  w^as  rather  swaying,  bending  the  body 
backward  wdth  each  step.  But  even  that  could  have 
been  remedied  if  the  parents  had  been  willing  to  con- 
tinue ;  they  think  she  will  outgrow  it  by  honre  practis- 
ing and,  of  course,  much  can  be  done  if  they  stick  to  it. 
II.  In  November,  19 14,  I  was  called  to  a  yoitng 
married  gentleman,  24  years  of  age.  Two  months  be- 
fore he  had  been  stricken  wdth  infantile  paralysis,  very 
high  fever,  and  for  a  while  given  up  by  the  physicians. 
Now  he  w^as  flat  on  his  back,  without  being  able  to 
mo've  a  single  muscle  in  either  leg  or  lower  part  of 


156  PRACTICAL   MASSAGE. 

the  back.  He  had  been  constipated  all  his  life  and 
had  taken  some  physic  every  day  to  move  his  bowels. 

The  expert  physician,  who  had  been  called  in  con- 
sultation, said :  "Massag-e,  and  nothing  else,  will  do 
yoii  any  good." 

I  began  with  massage  of  the  stomach,  then  gentle 
"combination"  kneading,  nerve  compression  and  fric- 
tion of  both  legs,  and  back  massage. 

Next  day  the  same  and  passive  movements. 

In  giving  massage  of  the  stomach  I  noticed  some- 
thing loosen  in  the  ascending  colon,  and  when  I  re- 
turned I  was  told  that  without  taking  any  medicine 
the  bowels  had  acted  and  he  had  passed  a  black,  hard 
lump,  which  probably  had  been  lodged  in  his  co'lon.  a 
long  time  and  caused  autotoxin.  He  has  ne\'er  taken 
any  physic  since. 

Gradually  I  led  this  patient  to  concentrate  his  will 
on  certain  muscles,  and  already,  at  the  end  of  the  first 
week,  he  could  move  the  quadriceps  and  patella  of  his 
right  leg. 

I  found  the  nerves  at  the  lumbar  spine  and  applied 
vibratory  pressure,  gave  muscle  kneading  and  percus- 
sion to  his  weak  muscles,  and  as  I  found  that  the 
gastrocnemius  was  inclined  to  contract,  I  applied 
stretching  by  bending  the  foot  upward. 

The  adductors  were  next  to  begin  to  show  life; 
then  we  worked  on  the  flexors  of  the  thigh  and  the 
abductors.  Dr.  Brown,  orthopedic  surg-eon  of  Boston, 
came  once  a  month,  and  he  ordered  hot  tul>bath  and, 
while  in  the  tub,  trying  tO'  draw  the  knees  up,  which 


iNl^ANilLh.   i'AKALYblb.  157 

worked  very  well.  The  patient  was  also  lying-  down 
with  a  pillow  under  his  lumbar  and  lower  dorsal  back, 
and  in  this  jx>sition  made  to  draw  in  his  abdominal 
muscles.  This  also  worked  well,  until  I  noticed  that 
he  beg^an  to  have  "backache"  from  the  pressure  of  the 
lumbar  vertebrae,  and  the  pillow  was  discontinued. 

Treatments  were  given  every  day  fo^r  one  month, 
then  six  times  a  week,  four  times  a  week  during  the 
third  month,  aud  finally  three  times  till  the  middle  of 
June.  Already  in  March  the  patient  had  rig^ged  up  a 
bar  between  two  doors  and,  by  taking  hold  of  this, 
would  raise  himself  up  and  stand  upright,  gradually 
beginning  to  move  his  body  in  different  directions. 
He  would  sit  on  a  table  and  move  his  legs  forward 
and  backward,  and  also  sideways,  etc. 

All  morning  he  was  in  a  chair  on.  his  piazza,  in 
sunshine  and  fresh  air.  His  little  wife  was  a  wonder 
of  a  helper  to  him ;  they  were  all  alone  and  I  felt  as 
if  they  were  my  own  children.  By  the  end  of  April 
we  rigged  up  two  long,  parallel  bars  (ten  feet)  in  the 
parlor,  and  here  he  stood  up  and  walked  forward  and 
backward  between  the  bars. 

In  J\Iay  he  was  given  braces  and  crutches,  and  he 
soon  learned  to  walk  pretty  well.  Then  the  two  went 
in  their  own  automobile  to  Canada,  where  the  im- 
provement steadily  continued.  He  still  uses  the 
crutches,  but  there  is  no  doubt  now  that  he  will  ulti- 
mately recover,  by  rest  and  judicious  exercises,  tO'  the 
great  astonishment  of  his  physicians,  who  never  ex- 
pected to  see  him  ou  his  feet  again. 


158  PRACTICAL   MASSAGE. 

Of  course,  this  young  man  was  an  intelligent  fel- 
low aiid  eager  to  do  his  best,  which*  helped  my  treat- 
ment greatly,  but  I  had  to  caution  him  frequently  and 
even  scold  him  for  doing  too  much.  I  had  to  put  the 
check-rein  on  him  as  on  a  wild  colt. 

These  two  cases  ought  to  give  some  idea  of  how 
to  treat  patients  with  this  malady. 


CHAPTRR  XXIT. 
Occupation  Neuroses. 

These  generally  occur  during  the  best  working 
period  of  a  man's  life.  The  illness  creeps  upon  one, 
and  its  course  is  slow.  Nctu'itis  in  any  of  the  nerve- 
roots  of  the  arms  or  even  in  plexus  brachialis  is  some- 
times the  cause  of  the  illness.  Often  there  is  great 
tenderness  over  the  nerves  of  the  arm;  but  more  fre- 
quently OA'er  the  muscles.  Excess  of  work  is  the  cause 
oi  the  trouble,  and  therefore  the  first  thing  to  do'  is 
to  quit  the  particular  work  which  has  produced  the 
neurosis.  Then  passive  movements  oi  the  arm  and 
centripetal  massage  should  be  applied.  But  where  the 
nerve  is  sensitive  and  tender  light  circular  kneading 
should  be  gi\-en,  and  often  the  sore  spot  entirely 
avoided  while  the  centripetal  massage  is  applied  a,bo>ve. 
This  is  especially  the  case  with  masseur  neurosis  and 
other  neuroses  occurring  after  very  hard  work. 

The  prognosis  is  not  always  good  in  occupation 
neurosis.  The  illness  may  follow  the  patient  all 
through  life;  although  I  believe  that  many  failures  to 
cure  it  have  come  from  too  hard  treatment.  My  per- 
sonal experience  is  that  moderate  and  even  very  light 
massage  will  produce  a  cure. 

Some  tinie  ago  a  gentleman,  druggist,  who  used  his 
left  hand  frequently  in  the  ice-basket  while  making  ice- 

(159) 


160  PRACTICAL   MASSAGE. 

cream  was  taken  ill  with  neuritis  of  the  median  nerve 

oi  the  left  ami  aiid.  hand.  P'oir  seven)  weeks  lie  was 
treated  by  his  physician  with  all  sorts  of  rem^edies, 
among  them  electricity  and  vibrator  machine,  but  he 
grew  steadily  worse  and  finally  was  unable  to  sleep, 
and  confined  to  his  room.  His  friends  had  told  him 
to  send  for  me,  but  his  doctor  said  "No, — what  could 
massage  do  when  electricity  and)  vibration  made  him 
worse?"  Nov/  he  changed  his  doctor  and  he  at  once 
sent  for  me.  The  patient  told  me  about  his  experience 
and  that  his  first  doctor  had  said  massage  would  ag- 
gravate the  trouble,  to  which  I  said  that  probably  the 
iBost  masseurs  vrould  do  so,  but  I  would  undertake  to 
give  him  five  treatments,  and)  if  he  by  that  time  felt 
no  relief  we  would  stop,  and  I  should  not  charge  him, 
but  if  he  was  better  he  should  continue  the  treatment. 

The  first  treatment  consisted  of  light  friction  from 
the  spine,  over  the  shoulder  and  down  the  ami,  and 
slight  pulling  of  the  anm — six  nuinutes  in  all.  The 
next  day  the  same  and  nerve  compression;  third  day 
the  same;  fourth  and  fifth  the  same  and  some  com- 
bination kneading  and  singie  anrr  rotation. 

After  the  fifth  treatment  the  patient  was  entirely 
well,  and  has  not  had  any  attack  later. 

writers'  cramp. 

These  movements  are  useful : — 

1.  Back  percussion. 

2.  Right  arm  centripetal  stroking,  kneading,  circu- 
latory friction. 


CHOREA.  161 

3.  Right  arm  rotcation. 

4.  Forward  trmilv  llexion  and  extension — sitting- 
resistive. 

5.  Right  arm  torsion — resistive. 

6.  Right  hand  and  finger  flexion  and  extension — 
resistive. 

7.  Right  arm  viljration. 

8.  Trunk  rotation — astride  sitting — passive. 

9.  Vertical  ami  flexion  and  extension — resistive. 
10.  Right  arm  nerve  compression,  rolHng,  slapping, 

and  friction. 

Cramp  of  the  Legs. 

1.  Thigh  rotation. 

2.  Leg  vibration. 

3.  Foot  flexion  and!  extension — resistive. 

4.  Trunk  torsion — sitting — resistive. 

5.  Leg  nerv^e  compression,  rolling,  and  friction. 

6.  Leg  flexion  and  extension — resistive. 

7.  Trimk  ele\'ation — lying — active. 

8.  Upward  knee  traction — resistive. 

9.  Breech  beating. 

10.  Leg  torsion — resistive. 

TT.  Leg  nerve  compression,  slapping,  and  friction. 

12.  Back  percussion  and  friction. 

Chorea. 

This  disease  has  been  treated  with  great  success  by 
the  Swedish  movement. 

M.  Napoleon  Laisne  has  applied  this  treatment  to 
11 


152  PRACTICAL   MASSAGE. 

hundreds  of  children  at  the  "Hopital  des  Enfants 
Malades,"  in  Paris,  with  the  greatest  success.  Dr. 
Blache,  the  president  of  this  hospital,  addressed  in  1851 
an  assembly  of  directors,  and  prominent  physicians 
upon  the  results  of  this  treatment.  He  closed  his  re- 
port by  saying  that  in  four  yea,rs  not  one  of  the  choi-eic 
children  thus  treated  had  suffered  a  relapse. 

Resistive  mo\'ements  followed  with  light  friction 
downward  of  the  parts  just  treated,  and  also  some 
active  exercises  according  to  command,  are  the  most 
beneficial. 

1.  Horizontal  arm  separation  and  closing — sitting 
— resistive. 

2.  Bent-knee  separation  and  closing — reclining 
— resistive. 

3.  Trunk  torsion^ — sitting — resistive. 

4.  Foot  flexion  and  extension — double — reclining 
— resistive. 

5.  Neck  flexion  and  extension — standing — resistive. 

6.  Vertical  arm  flexion  and  extension — lying — re- 
sistive. 

7.  Leg  flexion  and  extension — reclining — resistive. 

8.  Arm  torsion — sitting — resistive. 

9.  Back  percussion — standing. 

A  regular  course  of  Educational  Gymnastics  should 
be  given  for  several  years. 


CHAPTER  XXIII. 

Sciatic  Neuralgia. 

Of  all  writers  on  the  treatment  of  this  malady  Dr. 
J.  Schreiber  seems  to  have  had  the  most  cxi>erieiice  and 
to  have  been  the  most  successful  in  his  cures.  Upon 
this  subject  he  says: — 

"As  the  greater  number  of  sciaticas  which  have 
come  under  my  notice  have  been  combined  with  crural 
neuralg'ia  as  well,  I  think  it  best  to  consitler  these  two 
conditions  together.  It  seems  advisable,  also,  to  dis- 
cuss the  treatment  according  to  a  plan  which  may,  with 
suitable  modifications,  be  applied  tO'  each  special  case, 
and  yet  one  which  will  embrace  the  details  gleaned 
from  numerous  observations.     Let  us  take  a  case: — 

"A  patient  suffering  from  well-UTarked  sciatica  and 
crural  neuralgia  of  the  right  side  applies  for  relief,  after 
having  been  under  treatment  by  others  for  many  years 
in  vain.  He  has  used  veratria,  aconite,  and  belladonna 
ointnients,  moq^hine  injections,  electricity,  sinapisms, 
and  vesicants.  We  may  assume,  also,  that  for  a  con- 
siderable period  he  took  arsenic,  quinine,  and  potas- 
sium iodide  and  bromide,  that  he  has  l>een  to  a  number 
of  springs,  like  Gastein,  Wiesbaden,  Teplitz.  and 
Ragaz,  and  also  that  neither  sea-bathing  nor  hydro- 
therapy has  had  any  effect  upon  his  obstinate  malady. 
He  is  only  able  to  drag  himself  painfully  along  by  the 

(163) 


164  PRACTICAL  MASSAGE. 

use  of  a  cane,  and  every  step  causes  acute  suffering. 
Rising  and  sitting  down  can  only  be  accomplished  by 
aid  of  the  anns,  while  for  g'oing  upstairs  or  getting 
out  of  bed  the  assistance  of  an  attendant  is  necessary. 
He  is  never  entirely  free  from  pain,  and  there  is  gen- 
erally a  daily  exacerbation  lasting  often  several  hours, 
and  preventing  much-needed  rest. 

"Examination  shows  no  other  functional  disturb- 
ances. There  is  great  sensitiveness  in  the  buttock,  at 
the  point  of  exit  of  the  sciatic  nerve,  and  many  painful 
points  exist  along  the  outer  and  inner  aspects  of  the 
thigh.  The  limb,  furthermiore,  will  be  seen  to  be  held 
in  a  characteristically  pathognomonic  position,  namely, 
the  thigh  rotated  inward  and  adducted,  the  knee 
slightly  bent,  and  the  foot  not  resting  on  the  groiuid 
with  the  sole,  but  touching  it  with  the  toe  only. 

*'0n  sitting  down,  the  patient  supports  himself  by 
his  left  arm,  and  lets  himself  fall,  as  it  were,  upon  his 
left  buttock,  instead  of  perfonning  the  usual  move- 
ments of  flexion  with  knees  and  hips.  The  involve- 
ment  of  the  semitendinosus  and  semimembranosus 
muscles  causes  great  sensitiveness  to  pressure  over 
their  tendons.  Voluntary  abduction  of  the  affected 
thigh  is  impossible,  and  abduction  of  even  the  well 
extremity  cannot  be  performed  on  standing  erect,  on 
account  of  inability  of  the  patient  to  support  himself 
upon  the  affected  limb.  External  rotation  is  also  im- 
possible. Hence  it  appears  that  the  glutei,  the  pyri- 
formis,  the  internal  obturator,  and  the  gemelli  (ex- 
ternal rotators)  are  all  affected.     Nor  can  the  patient 


SCIATICA.  165 

flex  the  thigh  (involvement  of  the  ihac  and  psoas 
major),  nor  can  he  addiict  it  after  it  has  once  been 
passively  abducted  (involvement  o-f  the  sartorius,  in- 
ternal rectus,  adductors  longus,  brevis  and  mag-nus,  and 
pectineus).  But  the  greatest  pain  of  all  is  caused  by 
rotating  the  thigh  outward,  as  the  sciatic  is  thus  made 
to  glide  upon  and  rub  against  the  quadratus  femoris. 

"I  have  purposely  selected  a  case  in  which  all  the 
muscles  of  the  buttock,  alxDUt  the  hip-joint,  and  of  the 
thigh  have  become  involved,  and  hence  almost  entirely 
deprived  of  function.  Many  years  of  experience  and 
many  trials  have  convinced  me  that  the  cure  of  these 
forms  of  sciatica  will  be  most  rapidly  effected  when,  in 
addition  to  the  mechanical  interferences,  passive  and 
active  motions  of  all  the  affected  muscles  are  employed. 
It  has  also  seemed  to  me  best  to  begin  the  daily  treat- 
ment with  the  passive  and  active  movements,  leaving 
the  mechanical  manipidations,  which  are  very  painful, 
till  the  last.  They  cause  so  much  exhaustion,  as  a  rule, 
that  the  patient  is  anxious  only  for  rest,  and  will  hardly 
have  the  energy  necessary  for  performing  acts  which 
he  kno'ws  must  only  increase  his  suffering." 

If  the  cause  of  the  neuralgia  is  a  pressure,  as  froin 
a  tumor,  etc.,  it  is  of  no  use  to  try  this  treatment,  but 
otherwise  it  will  generally  effect  a  cure.  At  the  end  of 
each  day's  trea.tment  the  patient  will  generally  complain 
of  much  pain  and  fatigue,  which  usually  diminishes 
considerably  in  about  half  an  hour,  although  it  some- 
times lasts  for  hours  after^^^rd.  In  the  beginning, 
too,  the  night's  rest  may  be  more  broken  than  before. 


166  PRACTICAL   MASSAGE. 

In  six  to  twelve  days  usually  a  changfe  for  the  better 
occurs,  the  night's  rest  becomdng  more  tranquil,  the 
pain  less,  and  the  first  signs  of  approaching  conva- 
lescence begin  to  appear. 

Dr.  Schreiber  says :  "It  is  almost  a  matter  of  course 
that  the  physician  will  be  confronted  with  every  kind 
of  doubt  on  the  part  of  the  patient  regarding  the  ulti- 
mate results  of  treatment,  but,  as  failures  are  rare 
where  sufficient  perseverance  and  the  requisite  skill 
have  been  employed,-  he  may  confidently  combat  these 
miisappirehensions.  The  duration  of  the  treatment  will 
depend  on  the  following  various  factors : — 

"i.  On  the  previous  length  of  the  illness. 

"The  longer  the  disease  has  existed  the  more  pro- 
tracted will  have  to  be  the  treatment.  Eight  weeks 
will,  as  a  rule,  be  the  limit ;  at  least,  that  was  the  limit 
needed  to  cure  one  of  my  cases  of  a  previous  four 
years'  duration.  Cases  of  only  a  few  months'  standing 
often  need  but  ten  or  twelve  days  for  a  cure. 

"2.  On  the  extent  of  the  disease. 

"The  greater  the  number  of  muscles  involved  the 
more  numerous  must  the  number  of  corresponding  ex- 
ercises be,  and  hence  the  longer  the  time  required. 
"3.  On  idioisyncrasy.     Individual  peculiarity. 

*Tn  sensitive  individuals  it  is  often  necessary  to  pro- 
ceed very  cautiously  and  gently  at  first.  More  time  is, 
therefore,  required  in  these  cases  than  where  the  pa- 
tient is  not  of  a  timorous  or  complaining  dispo'sition. 

"4.  On  the  skill,  the  experience,  and  the  persever- 
ance of  the  physician. 


SCIATICA.  157 

"Familiarity  with  the  methods  frequently  enables 
a  practised  hand  to  employ  many  devices  which  an  in- 
experien.ccd  i)erson  veiy  pnii)erly  avoids. 

"5.  On  the  age  and  general  nutrition  of  the  patient." 

Two  very  interesting  cases  are  illustrated  by  Dr. 
Schreiber,  and  he  claims  to  have  cured  numerous  per- 
sons of  very  bad  sciatica.  His  mode  of  treatment  is 
in  its  character  the  same  as  I  have  been;  using,  but  as 
Dr.  Schreiber  already,  the  first  day  of  treatment,  uses 
some  kind  of  apparatus,  the  dcscrii).tion  l>elow  given 
shows  the  method  found  by  me  to  be  the  best  where 
the  patient  is  confined  to  his  room,  as  in  a  case  of 
sciatica  of  the  rig"ht  leg. 

The  first  day  the  treatment  must  be  very  gentle  and 
of  short  duration,  the  patient  lying  down. 

1.  Right  leg  flexion  and  extension — passive — four 
to  teil  times,  according  to  his  strength. 

2.  Right  leg  nerve  compression  and  rolling. 

3.  Breech  beating. 

4.  Right  leg  (back  of  the  thigh)  percussion  and 
friction. 

The  second  day  the  same  treatment  with  more 
force. 

The  third  day  the  following  is  applied: — ■ 

1.  Right  leg  flexion  and  extension — passive. 

2.  Right  leg  nerve  compression  and  rolling. 

3.  Right  thigh  rotation. 

4.  Right  leg  vibration. 

5.  Breech  beating. 

6.  Right  leg  nerve  compression,  percussion,  and 
friction. 


168  PRACTICAL   MASSAGE. 

The  fourth  day  give: — 

1.  Right  thigh  rotation. 

2.  Right  leg  flexion  and  extension — resistive. 

3.  Right  leg  nerve  compression  and  rolling. 

4.  Right  leg  sq>aration  and  closing — passive. 

5.  Right  foot  flexion  and  extensioii — resistive. 

6.  Right  leg  vibration. 

7.  Breech  beating. 

8.  Right  leg  nerve  compression,  percussion,  and 
friction. 

The  fifth,  sixth,  and  src'cnth  days  we  may  apply 
deep  kneading  of  all  the  muscles  of  the  buttock  and 
thigh,  just  before  "breech  beating"  and  "sciatic  nerve 
stretching,"  in  connection  with  the  former  prescription. 

The  next  four  or  five  days  the  following  move- 
ments should  be  used  : — ' 

1.  Thigh  rotation' — both  legs — passive. 

2.  Right  leg  flexion  and  extension — resistive. 

3.  Right  leg  nerve  compression  and  rolling. 

4.  Right  leg  torsion — passive. 

5.  Right  leg  separation  and  closing — resistive. 

6.  Kneading  and  beating  of  right  leg  andj  buttock. 

7.  Right  knee  upward  traction — resistive. 

8.  Right  foot  flexion  and  extension — resistive. 

9.  Right  leg  vibration. 

10.  "Sciatic  nen^e  stretching." 

11.  Right  leg  nerve  compression,  rolling,  and  fric- 
tion. 

The  last  prescription,  which  ma}^  be  continued  till 
the  patient  is  well,  has  a  more  all-sided  effect. 


SCIATICA.  169 

1.  Thigh  rotation — Ijoth  legs — passive, 

2.  Right  leg  iicrve  C()ini)ressi(jn,  rolling,  and  fric- 
tion. 

3.  Trnnk  rotaticni — astride  sitting — passive. 

4.  Right  leg  llexiun  and  extension — resistive. 

5.  Kneading-  and  beating-  of  right  leg-  and  buttock. 

6.  Forward  trunk  flexion  and  extension — sitting — 
resistive. 

7.  Bent-knee  separation  and  closing- — resistive, 

8.  Right  leg-  percussion. 

9.  Right  leg  torsion — resistive. 

10.  Breech  beating. 

11.  "Sciatic  nen-e  stretching." 

12.  Right  leg  nerve  compression,  rolling,  and  fric- 
tion. 

In  connection  with  this  it  will  be  of  great  advantage 
to  let  the  patient  walk  and  run  on  tiptoe,  and  to  go  up 
and  down  a  few  steps,  or  stairs.  There  should  also  be 
taken  good  care  that  the  patient  always  sits  straight 
and  rests  e\'enly  on  both  buttocks. 

Of  the  many  cases  of  sciatica  which  the  writer  has 
treated,  the  following  one  was  cured  in  the  shortest 
time,  considering  the  previous  duration  of  the  dis- 
ease : — 

A  lady,  29  years  old,  suffered  from  sciatica  for  ten 
months.  She  had  been  in  bed  most  of  the  time,  and 
all  kinds  of  treatment  had  been  tried  without  any  re- 
lief. One,  day  she  felt  well  enough  to  be  taken  in  a 
carriage  and  carried  into  the  writer's  Institute,  where 
the  movement  treatment  was  applied.     It  pained  her 


170  PRACTICAL   MASSAGE. 

a  great  deal,  but  after  awhile  it  gavel  her  relief,  and 
she  returned  the  next  day.  The  fifth  day  she  walked 
alone  to  the  Institute,  and  after  three  weeks'  treatment 
was  cured.  She  has  not  had  any  return  of  the  dis- 
ease since. 


CILVrTER  XXIV. 

Diseases  of  the  Organs  of  the  Circulation', 
chronic  heart  disease. 

Dr.  Gu.staf  Zander,  of  the  ]\Icchanico-Therapeu- 
tic  Institute  in  Stockholm,  says:  "In  heart  diseases, 
movement  treatment  is  an  uninterrupted  necessity,  at 
least  during  the  winter.  It  is  a  pity  when  in  such 
cases  the  patients  have  no  opportunity  to  use  this  treat- 
ment. It  is  astonishing  what  excellent  effects  regular, 
gentle,  but  many-sided  muscular  exercises  have  on  dis- 
eases of  the  heart.  Some  of  these,  when  not  too  far 
gone,  can  be  entirely  cured ;  others  can  be  stopped 
from  further  development,  and  all  can  be  relieved." 

From  Dr.  Hartelius,  the  Principal  of  the  Royal 
Central  G^nnnastic  Institute,  in  Stockholm.,  we  quo'te 
the  following : — 

"A  lady,  30  years  old,  with  a  dangerous  organic 
heart  disease — stenosis  of  left  osfiuiii  afriozrnfricular, 
zcith  insufficiency  of  mitralis.  The  action  of  the  heart 
was  very  weak.  The  patient  suffered  with  great  short- 
ness of  breath  and  painful  palpitations;  a  great  deal  of 
subcutaneous  effusion  in  the  lower  extremities  and  also 
considerable  effusion  in  the  peritoneum.  Her  aspect 
was  cyanotical. 

"Mild  chest  liftings  and  vibrations  were  given  to 
produce  strong  inspirations,  also  rotation  of  the  arms 

(171) 


172  PRACTICAL   MASSAGE. 

and  legs  to  increase  the  circulation,  gentle  rotation  and 
torsio'n  of  the  trunk  to  act  on  the  portal  system,  and 
centripetal  stroking  on  the  lower  extremities  tO'  pro- 
mote resorption  of  the  suljcutaneous  effusion.  In  the 
beginning  the  movements  were  very  mild,  but  gave 
relief  for  a  few  hours  at  a  time.  Later  the  movements 
were  applied  several  times  daily,  and  then  more  lasting 
effects  were  produced.  Patient  received  great  relief, 
more  strength,  and  the  effusion  was  lessened,  but  her 
organic  trouble  could  not  be  cured. 

"Experience  tells  us  that  each  difficult  heart  disease 
must  nearly  always  be  under  the  influence  of  move- 
ment treatment  in  order  to  secure  permanently  good 
results. 

A  weakened  circulation  is  the  necessary  consequence 
oif  every  heart  disease,  and  the  object  of  the  nuassage 
treatment  is  therefore  to  facilitate  the  work  of  the 
heart  by  improving  the  circulation.  Movements  must 
be  given  which  shall  diminish  the  pressure  of  the  blood 
and  decrease  the  activity  of  the  heart. 

Centripetal  massage  and  rotations  further  the  cir- 
culation, especially  in  the  more  peripheral  parts  of  the 
body;  and  respiratory  movements  do'  the  same  in  the 
chest. 

Inspiration  acts  as  a  pump  on  the  circulation  toward 
the  heart.  Muscle-contractions  produce  aj  pressure  on 
the  walls  of  the  blood-vessels,  whereby  the  blood  is 
forced  toward  the  heart ;  hence,  respiratory  and  circu- 
latory movements  are  here  of  great  value. 

As  before  said,  every  pressure  of  a  muscle  causes 


HEART   DISEASE.  173 

the  blood  to  be  squeezed  out  of  the  veins  of  the  mus- 
cles in  the  direction  toward  the  heart.  It  should  be 
remembered  that  kneadings  and  strokings  are  suffi- 
ciently strong-  to  press  together  the  veins,  and  thus 
further  the  flow  of  blood  to  the  heart;  but,  on  the 
contrary,  they  do  not  offer  any  hindrance  toi  the  free 
course  of  the  arterial  blood. 

It  is  known  that  the  veins  hold  more  when  they  are 
lengthened.  In  rotations  of  a  joint  a  frequently  re- 
peated elongation  and  shortening  of  tlie  numerous 
veins  take  place;  each  time  a  vein  is  elongated  the 
blood  is  sucked  up  from  the  peripherally  situated  tribu- 
taries, which,  in  their  turn,  react  in  a  circvilato^ry 
furthering  manner  on  the  capillaries.  On  the  shorten- 
ing of  the  veins,  which  immediately  follows,  they 
empty  their  contents  in  a  centripetal  direction.  Of 
special  importance  are  the  thigh  rotations  and  arm  ro- 
tations, because  a  strong  suction  arises  in  the  great 
veins  lying  near  these  joints. 

Trunk  rotations  have  especial  influence  on  the  in- 
ferior vena  cava,  but  to  a  slight  extent  also^  the  suj^erior 
vena  cava. 

Respiration  is  to  oxidize  the  blood,  and  in  heart 
disease  the  oxidization  of  the  blood  is  incomplete. 
Therefore,  it  is  of  the  greatest  importance  to  give  fre- 
quent respirator}'-  movements  to  these  patients. 

But  the  chest  also  ser\'es  as  a  blood-pump,  because 
deep  respirations  further  the  circulation.  Inspiration 
increases  the  negative  pressure  in  the  chest,  by  which  a 
strong  attraction  of  blood  to  the  heart  arises  in  both 


174  PRACTICAL   MASSAGE. 

of  the  venae  cavse.  Further,  the  diaphragm.,  in  con- 
tracting during  respiration,  expands  the  inferior  vena 
cava  and,  by  simultaneously  exercising  pressure  on  the 
abdominal  organs,  presses  the  blood  from  these  into 
the  veins. 

Dr.  Anders  Wide  says:  "Since  the  action  oif  the 
heart  is  facilitated  through  medical  gymnastics,  a  dis- 
eased heart  should,  to  a  certain  extent,  be  improved  by 
the  treatment.  This  ought  especially  to  be  the  case  in 
diseases  of  the  muscles  of  the  heart,  which  latter  are 
strengthened  by  the  treatment.  But  even  in,  valvular 
lesions  symptoms  of  failing  compensation  can  be  dimin- 
ished by  the  gradually  increased  work  given  the  heart. 
Heart  dilatation  should  also  be  diminished  by  facilitat- 
ing the  work  of  the  heart-muscle.  But  even  if  a  medi- 
cal gymnastic  treatment  cannot  free  the  patient  from 
heart  disease  itself,  and  only  in  few  cases  improve  it, 
still  I  dare  assert  that  every  patient  with  heart  disease 
will  obtain  relief  from  the  troublesome  symptoms  of 
palpitation,  shortness  of  breath,  pain  and  oppression 
over  the  heart,  with  other  symptoms  that  always  ac- 
company heart  disease;  and  even  this  is  much  to  be 
thankful  for.  It  is  true  that  the  improvement  will  not 
be  lasting  in  every  case,  l>ut  that  it  must  be  often  re- 
peated and  for  long  periods ;  but  it  should  also  be 
rememibered  that  the  disease  is  chronic  and  that  no 
other  treatment  gives  better  results." 

It  is  clear  that  the  same  kind  of  treatment  may  be 
used  for  nearly  all  kinds  of  heart  disease,  because  the 
object  in  every  case  is  to  facilitate  the  work  oi  the 


HEART    DISEASE.  I75 

heart.  Passive  moA^ements  are  of  the  greatest  impor- 
tance in  this  treatment,  but  some  resistive  movements 
are  also  of  great  value. 

In  arranging  a  treatment  for  heart  disease,  passive 
movements  only  should  be  used  to  begin  with,  and 
gradually,  as  the  patient  Ijecomes  stronger,  some  few 
resistive  exercises  may  be  added. 

Prescription  I. 

1.  Chest  lifting  and  vibration. 

2.  Foot  rotation,  double. 

3.  Arms — centripetal  stroking,  kneading,  and  fric- 
tion. 

4.  Legs — centripetal  stroking,  kneading  and  fric- 
tion. 

5.  Hand  and  finger  rotation,  flexion,  and  extension 
— passive. 

6.  Thigh  rotation. 

7.  Chest  percussion. 

8.  Loin  traction. 

9.  Leg  vibration. 

10.  Back  percussion  and  friction. 
This  should  be  gradually  increased  to  the  follow- 
ing:— 

Prescription  11. 

T.  Shoulder  rotation  and  chest  lifting — sitting — 
passive. 

2.  Thigh  rotation — reclining — passive. 

3.  Leg  flexion  and  extension — reclining — resistive. 


176  PRACTICAL   MASSAGE. 

4.  Arm  nerve  compression,  muscle  rolling,  slap- 
ping, and  friction — sitting. 

5.  Forearm  flexion  and  extension — sitting — resis- 
tive. 

6.  Trunk  torsion — sitting — resistive. 

7.  Chest  lifting  and  vibration — reclining — passive. 

8.  Foot  rotation — double — reclining — passive. 

9.  Leg  nerv'e  compression,  muscle  rolling,  slapping, 
and  friction — reclining. 

10.  Arm  rotation — single — sitting — passive. 

11.  Hand  and  finger  flexion  and  extension — resis- 
tive. 

12.  Trunk  rotation — astride  sitting — passive. 

13.  Chest  slapping — standing. 

14.  Shoulder   rotation  and  cliest  lifting — sitting — 
passive. 

A  short  rest  should  be  taken  between  every  exercise. 

The  so-called  "Schott"  treatment  by  exercise  is  a 
century  old  and  has  been  used  by  Ling  and  all  his  fol- 
lowers ever  since.  I  myself  have  been  using  the  same 
method  for  over  forty  years.  But  the  medical  profes- 
sion in  the  L'nited  States  did  not  wake  up  to  the  fact 
before  ''Schott"  was  thrown  at  them  in  medical  jour- 
nals. Up  to  twenty  3^ears  ago  the  advice  to  people 
with  heart  troubles  in  this  counry  was  always  "rest," 
"don't  move."  and  so  on.  Now  it  is  "exercise,"  "play 
gO'lf" ;  but  that  should  l>e  done  with  great  care.  A 
course  of  medical  gymnastics  by  an  expert  would  be 
better  and  safer. 


DISEASES   OF   THE   RESPIRATORY   ORGANS.     177 


FOR  COLD  HANDS  AND  FEET 

the  following  moveni/ents  are  very  useful: — 

1.  Forward  arm  rotation — sitting — passive. 

2.  Foot  rotation,   (loul)le — reclining — passive. 

3.  Vertical  arm  flexion  and  extension — sitting — ■ 
resistive. 

4.  Leg  flexion  and  extension — reclining — resistive. 

5.  Trunk  rotation — astride — passive. 

6.  Hand  and  finger  flexioii  and  extension — resis- 
tive. 

7.  Foot  flexion  and  extension — resistive. 

8.  Arm  nerve  compression,  rolling,  slapping,  and 
friction. 

9.  Leg  nerve  compression,  rolling,  slapping,  and 
friction. 

10.  Arm  vibration. 

11.  Foot-sole  slapping  and  friction. 

12.  Back  percussion  and  friction. 

Diseases  of  the  Respiratory  Organs. 

Catorrli  of  the  larynx,  caforrh  of  the. lungs,  conges- 
tion of  the  lungs,  'emphysenia  of  the  lungs,  spasmus 
hronchialis,  and  e\'en  tuberculosis  have  all  been  treated 
with  success  at  different  establishments  by  movements, 
but  each  of  them  requires  quite  a  special  treatment  by 
a  skillful  and  experienced  gymnast,  and  therefore,  only 
a  prescription  for  rrrovements  to  be  used  where  there  is 
a  disposition  to  a  lung  trouble,  showing  a  narrow  chest, 


178  PRACTICAL   MASSAGE. 

round  and  stooping  shoulders,  and  lack  of  muscular 
power,  is  here  given : — 

1.  Shoulder  rotation  and  chest  lifting — sitting. 

2.  Foot  flexion  and  extension — resistive. 

3.  Trunk  torsion — sitting — resistive. 

4.  Forward  ami  rotation — sitting. 

5.  Leg:  flexion  and  extension — reclining — resistive. 

6.  Horizontal  ami  separation  and  clo'sing — resis- 
tive. 

7.  Neck  flexion  and  extension — standing — resis- 
tive. 

8.  Forward  trunk  flexion  and  extension — sitting 
— resistive. 

9.  Lateral  arm  elevation  and  depression — sitting — 
resistive. 

10.   Chest  slapping. 

In  connection  with  these  exercises,  or  as  a  single 
treatment,  should  be  used 

Throat  massage,  and 

Chest  and  back  massage, 
and  also  freciuent  breathing  exercises  in  open  air. 

There  is  probably  nothing  better  for  lung  troubles 
than  the  methods  now  in  use:  Cleanliness,  good  and 
wholesome  food,  sleep  with  open  windows,  and  be  out 
of  doors  and  take  deep  breathing  exercises. 


CHAPTER  XXV. 

Diseases  of  the  Organs  of  Digestion. 

The  following  prescriptions  are  given  only  iur  the 
most  frequent  cases,  as  dyspepsia,  constipatioii,  and 
hyperemia  of  the  liver.  The  treatment  in  these  cases 
should  be  directed  to  strengthen  the  whole  system,  as 
well  as  to  act  locally  on  the  diseased  organ. 

DYSPEPSIA. 

If  the  patient  is  very  weak  it  will  be  necessary  to 
give  him  a  light  treatment  for  the  first  two  or  three 
weeks,  viz. : — 

1.  Arm  nerve  compression,  rolling,  slapping,  and 
friction. 

2.  Legs  the  same. 

3.  Stomach  vibration  and  friction. 

4.  Thigh  rotation. 

5.  Armi  vibration. 

6.  Chest  lifting  and  vibration. 

7.  Stomach  kneading  (circular)   and  frictio'n. 

8.  Leg  vibration. 

9.  Back  percussion  and  friction. 

When  the  patient  is  improved  and  has  gained  some 
strength,  not  confined'  to  bed,  the  following  should  be 
applied : — 

I.  Forward  arm  rotation — sitting — passive. 

(179) 


180  PRACTICAL  MASSAGE. 

2.  Stomach  kneading,  vibration,  and  friction. 

3.  Upward  knee  traction-^ — reclining — resistive. 

4.  Trunk  rotation — astride  sitting — passive. 

5.  Stomach  concussion  and  friction — lying. 

6.  Leg  elevation — lying — resistive. 

7.  Vertical  arm  rotation — sitting — passive. 

8.  Loin  traction — lying. 

9.  Leg  flexion  and  extension — reclining — resistive. 
10.  Back  percussion  and  friction. 

CONSTIPATION. 

If  the  patient  is  in  bed  a  local  manipulation  for 
about  five  to  ten  minutes  twice  a  dav  will  be  most 
effective,  viz. : — 

1.  Stomach  kneading,  vibration,  concussion,  and 
friction — five  to  ten  minutes. 

2.  Breech  beating. 

3.  Loin  traction. 

If  the  disease  is  of  long  standing  it  is  necessary  to 
apply  strong  muscular  nrovements,  as: — 

1.  Forward  trunk  flexion  and  extension — sitting 
— resistive, 

2.  L^pward  knee  traction — reclining — resistive. 

3.  Bowel  vibration — standing — passive. 

4.  Trunk  elevation — lying — active. 

5.  Trunk  rotation — astride  sitting — passive. 

6.  Stomach  kneading  and  friction — reclining. 

7.  Trunk  torsion — kneeling — resistive. 

8.  Forward  arm  traction — lying — resistive. 

9.  Loin  vibration — sitting — passive. 


DISEASES    OF    THE   ORGANS    OF    DIGESTION.     181 

10.  Breech  beating-^-standing — passive. 

11.  Stomach  kneading,  concussion,  and  friction. 

12.  Shoulder  rotation  and   chest  lifting — sitting — 
passive. 

In  connection  with  this  treatment,  the  patient  should 
l)e  taught  to  take  some  active  exercise  by  himself  every 
day,  separate  from  the  time  of  the  massage  treatment. 

1.  A  breathing  exercise. 

2.  Chopping  movement. 

3.  Harvesting  movement. 

4.  Lie  on  the  back  and  raise  both  legs. 

5.  Breathing. 

I  ha^■e  had  some  of  my  greatest  success  in  treating 
these  diseases.  Some  years  ago  the  German  ambas- 
sador at  A\'ashington  came  to  me  for  treatment  directly 
from  Dr.  IMezger,  and  he  wasi  so  greatly  pleased  with 
the  success  of  my  treatment  that  he  soon  brought  me 
a  number  of  foreign  ministers  and  the  United  States 
high  officials. 

But  of  all  cases  one  was  especially  remarkable.  A 
gentleman,  abo-ut  40  years  of  age,  came  to  me  in  Bos- 
ton some  years  ago.  He  told  me  a  pitiful  story.  He 
had  been  in  a  good  business,  but  commenced  to  drink, 
as  he  said  hiuTself,  one  bottle  French  Cognac  during 
the  day  and  half  a  bottle  at  night.  After  a  couple  of 
years  his  business  was  gone  and  he  himself  a  wreck. 
W^hen  he  came  to  me  he  had  not  been  drinking  for 
three  years,  but  he  had  stuffed  his  stomach  with  every 
kind  of  pills  and  medicine  to  get  relief  for  his  consti- 
pation.   Nothing  would  help  him  any  more ;  he  would 


182  PRACTICAL   MASSAGE. 

go  two  and  three  weeks  without  an  operation,  and  he 
looked  worse  than  any  man  I  had  ever  seen.  After 
five  days'  massage  he  had  his  first  natural  operation 
for  many  years,  and  he  gradually  gained  in  health. 
Four  months  later  he  was  entirely  changed,  had 
gained  flesh  and  strength,  had  good  appetite  and  daily 
movements  of  the  bowels,  and  he  is  today  a  prosperous 
and  healthy  business  man. 

HYPEREMIA  OF    THE   LIVER. 

The  following-cited  case  of  this  disease  will  be 
especially  interesting : — 

A  gentleman  of  middle  age  had  been  ailing  two 
years.  He  had  grown  very  lean,  the  skin  was  yellow, 
and  his  feet  and  ankles  were  swollen.  The  liver  was 
considerably  enlarged,  especially  the  left  lobe.  There 
was  no  organic  heart  disease,  but  there  was  a  mild  ca- 
tarrh of  the  lungs.  Operations  of  the  bowel  w^re  slow 
and  difficult.  He  was  treated  twice  every  day  by 
means  of  movements,  and  no  other  remedies  were  used. 
After  one  month'  the  patient  was  considerably  better, 
the  liver  was  smaller,  swelling  had  disappeared,  and 
his  appetite  and  flesh  had  increased.  After  the  second 
month,  having  been  treated  once  a  day,  the  patient 
was  cured. 

The  following  prescription  was  used : — 

1.  Shoulder  rotation  and  chest  lifting — sitting. 

2.  Foot  rotation,  double — reclining. 

3.  Trunk  rotation — astride  sitting. 


DISEASES    OF    THE   ORGANS    OF    DIGESTWN.     183 

4.  Vertical    ami    flexion   aiul    extension — resistive 
and  vertical  arm  rotation — passive. 

5.  T.diii   vibration — sitting. 

6.  Thigh  rotation — reclining, 

7.  Chest  lifting  and  vibration — reclining. 

8.  Leg  flexion  and  extension — reclining — resistive. 

9.  Stomach  kneading  and  friction — reclining. 
10.  Back  percussion  and  friction — standing. 

APPENDICITIS 

should  not  be  treated  by  massage.  But  I  have  good 
reasons  to  believe  that  persons  who  take  judicious  ex- 
ercise will  not  be  attacked  by  this  malady;  and,  further, 
I  earnestly  advise  that  circular  kiicadiiig  and  friction 
of  the  abdomen  should  be  used  at  the  first  "threaten- 
ing" of  appendicitis.  Often  we  hear  of  persons  who 
have  been  ''threatened"  one  or  more  timies,  and  even 
been  told  that  it  was  nothing  more  than  indigestion, 
and  some  time  later  they  have  suddenly  been  taken 
violently  ill,  and  a  surgical  operation  had  to  be  resorted 
to.  If  these  cases  had  been  treated  by  massage  from 
the  first  day  of  the  symptoms,  I  do  not  hesitate  to  say 
that  the  appendicitis  would  have  been  avoided. 

INDIGESTION"    AND    BILIOUSNESS 

can  often  be  quickly  cured  by 

1.  Breathing  exercises. 

2.  Standing  and  bend  the  trunk  forward  and  back- 
ward, and  from  side  to  side. 


184  •  PRACTICAL   MASSAGE. 

3.  Vertical  arm   rotation — sitting'— passive. 

4.  Loin  vibration — sitting. 

5.  Trunk  rotation — astride  sitting — passive. 

6.  Circular  kneading  of  the  abdomen — reclining. 

7.  Back  percussion — standing. 

OBESITY 

is  frequently  treated  with  success  by  massage,  but  it 
must  be  pretty  hard  treatment  and  kept  up  regularly 
for  some  time,  and  some  strong  active  movements 
should  i:!e  used  also,  all  according  to  the  patient's 
srength. 

1.  Forward  trunk  flexion  and  extension — sitting — 
resisti^-e. 

2.  Backward  leg  traction — standing — -resistive. 

3.  Vertical   arm   flexion   and   extension — sitting — 
resistive. 

4.  Trunk  torsion — kneeling — resistive. 

5.  Upward  knee  traction — reclining — resistive. 

6.  Chopping  nTovement — standing — active. 

7.  Harvesting  movement — standing — active. 

8.  Forward  ami  traction — lying — resistive. 

9.  Leg  elevation — lying — resistive. 

10.  ]\'Iuscle  and  knuckle  kneading  of  the  abdomen. 

11.  Forward  arm  rotation — sitting — passive. 

12.  Back  percussion — standing. 


URINARY  AND  SEXUAL  ORGANS.  185 

Diseases  of  Urinary  and  Sexual  Organs. 

CHRONIC    catarrh    OF    TIIE' BLADDER. 

Tlic  movements  slmuld  ])e  (len'\ati\e  f  n  >m  the  pel- 
\is  and  ntlierwise  l)e  directed  according  to  the  [jatient's 
condition — for  instance  : — 

1.  Thigh  rotation — reclining. 

2.  Breech  beating — standing. 

3.  Bent-knee  separation  and  closing — resistive. 

4.  Forward  trnnk  flexion  and  extension — sitting — 
resistive. 

5.  Leg  torsion,  doul)]e — reclining — resistive. 

6.  Breech  beating — standing. 

7.  Lateral  arm  elevation  and  depression — standing 
— resistive. 

8.  Foot  rotation,  double — reclining. 

CHRONIC    CATARRH    OF    THE    WOMB. 

1.  Back  percussion  and   friction — standing. 

2.  Breech  beating- — standing. 

3.  Leg  separation  and  closing — reclining — resistive. 

4.  Forward  arm  rotation — sitting. 

5.  Tnmk  rotation — astride  sitting. 

6.  Knee  flexion  and  extension — reclining — resis- 
tive. 

7.  Forward  trunk  flexion  and  extension — sitting — 
resistive. 

8.  Breech  beating — standing. 

9.  Trunk  torsion — kneeling — resistive. 

10.  Back  percussion  and  friction — standing. 


186  PRACTICAL   MASSAGE. 

Displacement  of  the  ivouih  and  irregular  and 
painful  menstruation  are  often  not  only  relieved 
but  even  cured  by  movement  treatment,  but  these  cases 
require  a  special  study  and  experience,  and  ought  to 
be  treated  by  a  physician.  Still,  in  connection  with  his 
treatment,  it  would  be  of  great  value  toi  the  patient  to 
have 

Thigh  rotations — reclining — passive. 

Trunk  torsion — kneeling — resistive. 

Bent-knee  separation  and  cloising — resistive. 

Hand  and  toe  lying — active. 

Breech  beating — standing. 

Vibration  at  the  small  of  the  back. 


CTT APTKR  XXVI. 

Diseases  of  the  Organs  of  Movement, 
scoliosis. 

Ix  "lateral  ciiri'aliirc  of  (he  spi)ic."  where  the  mus- 
cles on  the  convex  side  are  weakened  and  pathologi- 
callv  changed,  and  the  muscles  on  the  concave  side 
normal,  it  is  clear  that  the  weakened  muscles  on  the 
convex  side  must  be  strengthened  and  developed.  Ac- 
cording to  Dr.  T.  J.  Hartelius,  "The  restoration  of  a 
pathologically  changed  muscle  canno't  l>e  produced  by 
mechanical  extensions,  but  only  by  muscular  exercise 
and  electricity. 

"But,"  he  says,  "for  the  restoration  of  a  curved 
spine,  extension  is  necessary.  The  question  is,  there- 
fore, whether  this  can  be  effected  by  the  organism's 
own  remedies.  This  is  easy  enough  to  prove.  In  mild 
cases  of  lateral  curvature,  where  there  is  not  yet  any 
deformitv  in  the  vertebra?,  the  spine  is  straightened  at 
each  extension  of  the  back.  By  flexion  to  the  convex 
side  the  spine  is  not  only  straightened,  but  it  can  be 
bent  so  far  as  to  display  a  curve  toi  the  other  side.  In 
cases  where  the  deformity  of  the  vertebrae  makes  a  full 
extension  of  the  spine  impossible,  it  is  still  possible  by 
its  own  strength  to  produce  an  extension  in  its  highest 
degree. 

"For  instance,  in  a  'forward  trunk  fllexion  and  ex- 

(187) 


188  PRACTICAL   MASSAGE. 

tension'  the  patient  stands  supported  on  the  thighs  and 
bends  forward ;  when  he  raises  himself  up,  the  operator 
resists  him  on  the  neck.  Or,  in  'backward  trunk 
fletxion'  the  patient  is  lying*  on  the  front  of  his  legs  and 
i^aises  the  back  up  backward. 

"These  and  a  few  other  active  and  resistive  move- 
ments can,  better  than  any  other  mechanical  remedy, 
straighten  out  the  curved  parts." 

In  a  one-sided  scoliosis,  for  instance,  witli  the  con- 
vexity to  the  left,  "lateral  trunk  flexion  tO'  the  left" 
may  be  given.  The  operator  puts  his  hands  on  the 
highest  point  of  the  curve  and  resists  the  patient  when 
he  bends  do^Mi.  This  can  be  performed  either  with 
the  patient  sitting,  standing,  or  lying  on  his  right  side, 
the  last  one  being  the  most  powerful  and  effective. 
Several  other  movements  are  alsO'  given  with  the  view 
and  intention  of  strengthening  the  muscles  on  the  con- 
vex side  and  straightening  out  the  spine,  and  should 
be  used  according  to  the  strength  of  the  patient  and 
the  particular  shape  of  the  defonnity. 

Dr.  Schreiber  says :  "The  treatment  of  scoliosis  by 
the  Ling  system,  which  has  scored  some  of  its  greatest 
successes  in  this  very  department,  requires,  however, 
quite  a  special  study,  and  can  hardly  be  carried  out 
without  both  apparatus  and  trained  assistants." 

Dr.  M.  Eulenberg,  in  "Die  Schwedische  Heilgyrrr- 
nastick,"  Berlin,  1853,  says: — 

"Ling's  method  is  the  only  truly  rational  therapeu- 
tic means  for  the  cure  of  chronic  disturbances  of  rno- 
tivity,  such  as  result  from  spinal  cun'ature,  and  from 


LATERAL  CURVATURES  OF  THE  SPINE.   189 

pseudooiieliylosis,  the  phthisical  tendency,  pigeon- 
breast,  peripheral  paralysis,  etc. 

**Even  in  cases  of  paralysis  from  lesions  of  the  cord, 
it  may  still  effect  a  cure  where  all  other  measures, 
undertaken  after  the  original  diseases  have  nm  their 
course,  will  be  found  useless.  Ling's  gymnastics  have 
an  even  greater  and  more  certain  effect  upon  enerva- 
tion and  nutrition  than  the  common  fonn.  of  gymnastic 
exercises.  Spinal  (lateral)  curvatures,  resulting  from 
faulty  carriage  (in  consequence  of  a  preponderance  of 
muscular  force  on  one  side  oi  the  body) ,  are  nowadays 
never  treated  liy  any  good  orthopedist  by  any  other 
means  than  the  Swedish  system." 

Any  one  who  will  undertake  the  treatment  of  scolicv- 
sis  should  make  it  a  special  study,  as  it  requires  great 
experience,  skill,  and  knowledge  to  lead  it  on  success- 
fully. 

However,  we  can  do  so  much  good  to  the  growing 
child  with  a  few  corrective  exercises,  that  it  seems  a 
pity  not  to  try  it.  And  my  experience  has  told  me  that 
a  person  with  good  common  sense,  and  carefully  watch- 
ing the  effect  of  every  exercise  on  the  bare  back  of  the 
child,  is  able  to  correct  and  cure  most  cases  of  lateral 
curvatures  when  taken  in  time. 

In  Brookline  (Mass.)  public  schools  I  organized  a 
clinic,  where  the  children  suffering  with  scoliosis,  lor- 
dosis, kyphosis,  pigeon-breast,  roimd-shoulders,  etc., 
are  examined  and  given  a:  prescription  of  exercises  to 
practise  at  home,  every  day,  and  once  a  week  they  are 
treated  at  the  clinic.     Among  the  scores  of  children 


190  PRACTICAL   MASSAGE. 

who  have  been  successfully  treated  this  way,  I  believe 
the  following  six  illustrations  will  be  sufficient  to  sho'W 
how  to  apply  the  movements  in  the  different  cases. 
But  every  exercise  should  be  watched  with  great  care, 
as  it  often  happens  that  the  same  exercise  may  be  bene- 
ficial to  one  and  harmful  to  another  case  cxi  seemingly 
the  same  kind  of  a  curve. 

In  all  cases  of  "double-curvature"  a  firm  pressure 
should  be  made  on  the  highest  convexity  at  either  side 
during  Jiauguig  and  trunk  raising. 

Of  course,  it  will  be  understood  that  the  heavy  line 
on  the  illustrations  represents  the  lateral  curve  of  the 
spine  when  first  examined,  and  the  dotted  line  the  spine 
at  the  last  examination ;  the  short  lines  at  the  sides  are 
the  lower  ends  of  the  scapulse. 

For  lordosis  I  use  especially  three  exercises,  viz : — ■ 

1.  Standing  with  arms  over  head  and  bending  the 
trunk  forward  and  downw^ard,  touching  the  floor  with- 
out bending  the  knees. 

2.  Hanging  and  raising  the  legs  forward. 

3.  Lying  and  pulling  both  knees  way  up  to  the 
chest. 

For  "pigeon-breast"  : — 

1.  L}nng  on  hands  and  toes  and  bend  and  stretch 
the  arms. 

2.  Hanging  with  arms  well  apart  and  pull  up. 

3.  Florizontal  arm  flexion  and  extension — resistive. 

4.  Horizontal  arm  separation  and  closing — resis- 
tive. 


LATERAL  CURVATURES  OF  THE  SPLNE.   I9I 


i 


^M«*^ 


■>oi\ 


Fig.  64.— Girl,  12  Years  Old.  First  examined  October,  1902; 
last  examined  March,  1903.  Five  home  exercises  and  at  the 
clinic. 


1.  Hanging — neck    flexion    and   extension — resistive. 

2.  Lying  on  right  side — bend  trunk  to  the  left — active. 

3.  Hanging — leg    separation    and    closing — resistive. 

4.  Hanging— raise  both   legs  forward— active. 


192 


PRACTICAL  MASSAGE. 


%ll 


mi 


j9Cl3\\/90^ 


Fig.  65.^ — Girl,  13  Years  Old.  First  examined  October,  1902; 
last  examined  February,  1903.  Five  home  exercises  and  at  the 
clinic. 

1.  Hanging — neck    flexion    and    extension — resistive. 

2.  Lying — leg   elevation— active. 

3.  Right   arm    upward   stretch — sitting — resistive. 

4.  Hanging — raise    both    legs    to    the    left— active. 


LATERAL  CURVATURES  OF  THE  SPINE.   193 


Fig.  66. — Girl,  14  Years  Old.     First  examined  October,  1902; 
last  examined  February,  1903.     Four  home  exercises  and  at  the 


clinic. 


1.  Hanging — neck   flexion    and   extension — resistive. 

2.  Lying   on   right  side — raise  left  leg— active. 

3.  Standing — stretch   right   arm   upward — active. 

4.  Hanging— raise  both  legs  to  the  left— active. 


13 


194 


PRACTICAL   MASSAGE. 


heVv 


■  JUNC 


I 
J 

Fig.  67. — Girl,  15  Years  Old.  First  examined  February,  1901  ; 
last  examined  June,  1901.  Prominent  lordosis  and  severe  back- 
ache.    Home  exercises  onlj^ 

1.  Arm   elevation    forward   and    upward — standing. 

2.  Leg   elevation — lying. 

3.  Right  arm — upward   stretch. 

4.  Standing   with   right  hand   on   neck — raise  right   leg  sideways. 

5.  Standing    with    trunk    bent   forward — horizontal    arm    flexion    and 

extension. 

6.  Lie   on  stomach — raise  right  leg   backward. 

7.  The  same  as  No.  2. 


LATERAL   CURVATL'RES    01'   THE   SPIXE.      195 


/ 


.]^, 


{$0i\\l99l 


Fig.  68.— Boy,  12^'  Years  Old.  First  examined  October,  1902; 
last  examined  March,  1903.  Five  home  exercises  and  at  the 
clinic. 

1.  Forward  trunk  flexion   and  extension — sitting    with    left    hand    on 

neclv  and  right  hand  on  hip — resistive. 

2.  Hanging — neck    flexion    and   extension. 

3.  Lying— back   curving — active. 

4.  Lying — leg  elevation — active. 

5.  Hanging— raise    legs    backward    and    forward— active. 


196 


PRACTICAL   MASSAGE. 


/ 


\ 


Fig.  69.— Girl,  13  Years  Old.  First  examined  October,  1903; 
last  examined  March,  1904.  Five  home  exercises  and  at  the 
clinic. 

1.  Hanging— neck  flexion   and   extension — resistive. 

2.  Back  curving — lying— active. 

3.  Log   elevation — lying — active. 

4.  Forward  trunk  flexion  and  extension — standing   with   thighs   sup- 

ported at  a  bar — resistive. 

5.  Legs    separated    and    closing — hanging — resistive. 

at  a  bar — resistive. 

For  more  information  about  "Scolio'sis"  see  Robt. 
W.  Lovelt's  "Curvatures  of  the  Spine." 


CHAPTER  XXVII. 

Rheumatism. 

"]\Iyitis" — in/lamiiiafioii  of  a  iiiusclc,  is  one  of  the 
niO'St  frequent  ailments  treated  by  massiige.  It  occurs 
oftenest  in  the  muscles  of  the  neck  and  in  the  glutei — 
the  buttocks — the  back  and  thorax,  and  in  the  muscles 
of  the  arms  and  legs.  But  no  muscle  can  be  considered 
immune  from  these  insidious  inflamimations  of  un- 
known origin,  as  they  are  found  in  the  most  protected 
places. 

"The  pains,  whether  localized  within  a  muscle  or 
in  an  extensive  nerve  area,  are  of  an  extremely  change- 
ful character,  being  now  very  sharp,  as  in  lumbago 
('back-shot'),  which  usually  is  due  to  myitis  in  the 
Iuml>ar  muscles,  oftenest  of  all  in  the  sacrolumbalis ; 
or  dull  and  diffused,  so  that  they  rather  resemble  the 
sensation  of  fatigue  and  correspond  usually  with  the 
pains  of  anemia  and  chlorosis."     (Dr.  Kleen.) 

It  can  arise  f rim  different  causes ;  generally  the 
rheumatism  occurs  in  weakened  muscles,  from  being 
exposed  to  draughts  or  dampness,  but  even  external 
injuries  and  too  much  work  with  one  set  of  muscles 
are  often  the  cause  of  these  ills.  But  the  S}nnptoms  are 
the  same — pain  and  ache,  when  using  the  diseased  mus- 
cles; diminution  or  cessation  of  function;  tenderness 
on  pressure,  and  often  swelling  of  the  muscle. 

(197) 


198  PRACTICAL   MASSAGE. 

Dr.  J.  Schreiber  says :  "We  find  that  mechano'- 
therapy  nowhere  meets  with  more  success  than  in  the 
treatment  of  muscular  rheumatism. 

"Any  physician  who  has  busied  himself  at  all  with 
mechanical  therapeutics  must  have  seen  dozens  of  cases, 
abundantly  proving-  the  assertion  made  by  Matin  in  the 
Socicte  de  Mcdccine  of  Lyons  as  far  back  as  1837  (and 
since  confirmed  by  Bonnet),  that  recent  myalgias,  no 
matter  how  severe  or  extensive,  whether  called  lum- 
bago, 'stiff-neck,'  or  what  not,  are  capable  of  being 
cured  by  a  single  application  of  massage. 

"A  case  of  Stromeyer's  is  worth  repeating  here.  A 
country  doctor,  who  was  accustomed  to-  visit  his  pa- 
tients on  horseback,  was  attacked,  after  having  been 
for  some  time  in  a  draughty  bam,  with  the  most  in- 
tense muscular  pain  in  all  parts  of  his  body.  An  old 
peasant  advised  him  to  mount  his  horse  again,  as  move- 
ment and  exercise  often  dispelled  these  pains.  He  did 
so,  though  it  required  the  help  of  several  men  to  lift 
him  into  the  saddle.  The  first  paces  of  the  horse 
caused  most  intense  suffering,  but  gradually  the  pain 
diminished.  A  thunderstormi  now  coming  up,  the  doc- 
tor put  his  horse  to  the  top  of  his  speed,  which  caused 
him  to  arrive  home  in  a  great  perspiration,  but  en- 
tirely free  from  pain. 

"The  words,  'arise  and  walk!'  may  be  confidently 
said  to  any  one  suffering  from  a  recent  neuralgia  who 
will  but  submit  to  treatment ;  the  power  of  motion  re- 
turning almost  invariably  after  the  first  application.'' 

My  experience,  however,  has  told  me  that  whenever 


MUSCULAR  RHEUMATISM.  I99 

myitis  is  caused  l)y  (ner\v(M-k,  tlie  muscles  should  be 
stretched  out  passi\ely  and  gentle  centripetal  massage 
applied,  but  no  muscular  exercise.  This  I  have  had 
aDundant  occasion  to  experiment  with  in  my  own  case, 
as  my  work  has  fre(iuently  prixluced  the  most  excru- 
ciating;- pain  in  my  arms,  sometimes  in  my  leg's,  which 
always  was  agg-ravated  by  movements  or  hard  mas- 
sage, but  immediately  relieved  and  cured  by  stretching 
and  gentle  massage. 

In  all  O'ther  cases  I  agree  that  good  hard  kneadings, 
percussion,  and  Ijeating,  together  with  passive  and  re- 
sisti\e  exercise,  should  be  used;  and  the  following 
prescriptions  will  probably  be  sufficient  tO'  show  how 
the  treatment  ought  to  be  : — 

MUSCULAR    RHEUMATISM. 

A.     Of  the  Right  Arm. 

1.  Centripetal  stroking,  kneadings,  and  circulatoi'y 
friction  of  right  arm. 

2.  Thigh  rotation — reclining. 

3.  Right  arm  muscle  beating. 

4.  Trunk  rotation — astride  sitting. 

5.  Right  arm  flexion  and  extension — resistive. 

6.  Leg  flexion  and  extension — resistive. 

7.  Right  arm  torsion — resistive. 
*   8.  Tlie  same  as  No'.  i. 

9.   Back  percussion. 


200  PRACTICAL   MASSAGE. 

B.     Of  the  Neck. 

1.  Forward  arm  rotation — sitting. 

2.  Head  rotation — sitting, 

3.  Foot  rotation — reclining. 

4.  Neck  percussion — sitting. 

5.  Horizontal  arm  separation  and  closing — resis- 
tive. 

6.  Trunk  torsion — kneeling — resistive. 

7.  Neck  flexion  and  extension — resistive. 

8.  Knee  flexion  and  extension — sitting — resistive. 

9.  Centripetal  stroking,  kneadings,  and  circulatory 
friction  of  the  neck. 

10.  Back  percussion  and  friction. 

C.    Liimhago. 

1.  Forward  trunk  flexion  and  extension — sitting — 
resistive. 

2.  Thigh  rotation — reclining — passive. 

3.  Stomach  massage. 

4.  Trunk  rotation — astride  sitting — passive. 

5.  Breech  beating — standing — passive. 

6.  Vertical   arm   flexion  and   extension — sitting — ■ 
resistive. 

7.  Bent-knee   separation   and   closing — reclining — ■ 
resistive. 

8.  Muscle    kneading,    percussion,    vibration,    and 
friction  all  over  the  small  of  the  back  and  the  buttocks. 

These  three  examples  show  how  to^  arrange  the 


MUSCULAR  RHEUMATISM.  201 

treatmeiiL  in  the  different  cases  of  muscular  rheuma- 
tism. Of  course,  if  the  patient  is  tooi  sick  to  take  tlie 
full  prescription,  we  only  a|>]ily  the  local  treatment 
until  he  is  able  to  take  the  whole,  which  has  in  \iew 
the  increasing'  of  the  circulation  antl  i;M\ing"  nutrition 
to  the  \\hole  system,  as  well  as  to  relieve  the  local 
disease. 

^\  few  interesting  cases  it  may  be  \vell  to  give 
here : — 

One  September  a  lady,  55  years  old,  came  to  me. 
She  was  5  feet  6  inches  tall,  and  weig-hed  230  pounds. 
She  complained  of  rheumatism  in  her  legs  and  anns, 
and,  could  only  walk  up  one  flight  of  stairs,  and  that 
with  the  greatest  difficulty.  On  her  arrival  she  was 
gasping  for  breath  and  sat  down  tO'  rest  for  nearh-  an 
hour. 

Eight  weeks  later,  having  taken  treatment  every 
day,  the  lady  asked  if  she  might  walk  up  tO'  the  top  of 
the  Washington  ]\Ionument  (about  nine  hundred 
steps).  Although  knowing  that  she  had  improved 
marvelously  and  had  lost  nearly  thirty  pounds,  I  told 
her  that  it  would  be  better  not  to  try  it  then,  because 
there  was  no  one  to  carry  her  down  again  if  she  be- 
came too  tired. 

She  laughed  and  said  that  she  had  walked  up  the 
monument  the  pervious  day,  looked  aroimd  for  half  an 
hour,  and  walked  down  and  to  her  home,  about  a 
quarter  of  a  mile  distant.  She  felt  veiy  well  after  it, 
and  had  no  lameness  or  pain. 

After  ten  weeks'  treatment  the  lady  was  entirely 


202  PRACTICAL   MASSAGE. 

well,  having  had  no  rheumatism  foir  the  last  five  weeks, 
and  her  weight  was  then  196  pounds.  The  next  sum- 
mer she  called  to  say  that  she  still  felt  like  a  young 
girl,  and  was  going  West  to  live  for  the  rest  of  her  life. 

Other  cases  are  as  follow : — 

A  gentleman,  31  years  old,  had  suffered  with  mus- 
cular rheumatism  in  his  right  shoulder  and  arm  for 
two  weeks.  He  had  not  had  any  relief  or  sleep  for 
several  days  when  he  came  to  me.  Fi^'e  days  later  he 
was  cured. 

Dr.  N.  N.,  46  years  old,  had  been  in  bed  about  three 
weeks  ^^•itll  a  very  painful  lumbago,  and  was  unable  to 
mo've  himself  when  he  sent  for  the  author. 

Massage  treatments  were  applied  six  times,  after 
which  he  was  out  attending  to  his  own  business. 

A  gentleman,  42  years  old,  had  suffered  from  lum- 
bago and  indigestion  for  nearly  eight  months,  and  had 
given  up  all  kinds  of  treatment.  On  the  advice  of  one 
O'f  his  friends  I  was  called  in.  The  patient,  who'  had 
once  been  a  very  strong  and  healthy  laborer,  was  run 
down  to  a  thin,  very  feeble-looking  man.  He  did  not 
believe  in  the  treatment,  but  he  submitted  tO'  a  trial  of 
it.  The  first  treatment  being  satisfactory,  it  was  con- 
tinued every  day.  The  impro'vement  was  remarkable. 
The  pain  became  less  and  less,  and  the  appetite  and 
strength  were  increased  every  day. 

After  three  weeks'  treatment  the  patient  had  gained 
twelve  pounds,  and  he  was  well  enough  to  attend  to 
his  business.     The  treatment  was  then  discontinued. 

Half  a  year  later,  when  he  felt  some  symptoms  of 


ARTIIKITIS.  203 

tlie  lunil>ag-(:),  he  came  to  the  Institute  and  took  one 
month's  treatment.     He  has  been  well  ever  since, 

A  gentleman,  33  years  old,  big"  and  strong,  had  re- 
turned from  a  hunting  trip  and  was  attacked  with  a 
severe  "lumbago."  When  I  arrixed  he  had  Ik'cu  in  bed 
four  hours  and  groaned  with  pain.  I  first  applied 
"thigh  rotation"  and  "abdominal"  massage ;  then  he 
was  gently  turned  over  and  a  vigorous  massage  of  the 
back  and  buttocks  was  contiiuied  for  nearly  an  hour, 
when  he  got  out  of  bed,  dressed,  and  with  a  light  step 
walked  downstairs  to  enjoy  his  dinner. 

In  the  winter  of  19 13  I  v/as  in  Portland,  Oregon, 
and  while  giving  a  lecture  to  the  medical  profession 
there,  I  claimed  that  I  would  cure  any  "lumbago"  sent 
me,  iu  from  two  to  six  treatments.  One  of  the  well- 
known  physicians  immediately  stood  up  and  said  that 
he  would  vouch  for  me,  as  he  himself  had  come  to  me 
one  morning  in  a  verv  bad  condition  and  had  one  treat- 
ment at  my  office ;  later  in  the  afternoon  I  had  come  to 
him  and  given  him  another,  after  which  he  dressed 
and  went  to  a  banquet  and  had  been  well  since. 

In  less  than  a  week  after  this  I  had  six  lumbago 
cases  sent  to  me,  each  of  which  were  cured  in  two 
treatments. 

Rheumatism  of  the  Joints, 
arthritis. 

This  disease  is  a  very  difficult  problem  tO'  handle 
with  massage,  and  must  be  done  with  great  care  and 


204  PRACTICAL   MASSAGE. 

gently,  otherwise  the  inflammation  wih  be  increased. 
Often  it  happens,  if  massage  is  applied  tO'  one  joint 
and  it  seems  to  improve,  that  the  inflammation  will 
settle  in  some  other  joint.  Still,  even  that  may  be 
better  than  to  allow  the  inflammation  tO'  stay  in  one 
place.  At  least,  I  have  seen  a  few  cases  where  the 
elbow  was  first  attacked,  then  the  shoulder,  and  after 
the  third  treatment  the  hip;  again  the  shoulder,  but 
Anally  disappeared,  and  were  ciu'ed  in  six  to  eight 
treatments.  But  I  do  not  care  for  these  cases,  and 
would  rather  not  treat  them,  as  they  arei  very  unsatis- 
factory. 

Whenever  I  do  give  treatment  for  arthritis  I  al- 
ways begin  with  a  good  thorough  massage  of  the 
stomach,  and  prefer  to  give  massage  tO'  the  whole  body 
— always  centripetal  stroking  and  circular  kneading  of 
both  arms  and  legs — and  when  soreness  has  disap- 
peared passive)  flexion  and  extension,  and  rotation  of 
every  joint. 

If  the  joints  are  stiff  and  cannot  be  moved,  local 
manipulation,  as  follows,  are  useful : — 

Centripetal  stroking,  pressing,  kneading,  heating, 
and  friction  of  the  diseased  part  and  surrounding  mus- 
cles, from  ten  to  twenty  minutes,  will  include  the  full 
treatment  for  some  time,  and  even  for  months ;  but 
when  the  joint  finally  responds  tO'  the  treatment  and 
allows  of  some  motion,  it  will  be  most  effecti\-e  to  treat 
it  after  the  following  method,  given  for  rheumatism 
of  the  right  knee: — 


ARTHRITIS.  205 

1.  Centripetal  stroking,  kneading-,  beating,  and 
friction — live  minutes. 

2.  Right  leg  flexion  and  extension — resistive. 

3.  Trunk  rotation — astride  sitting. 

4.  Right  knee  muscle  rolling — reclining. 

5.  Forward  arm  rotation — sitting. 

6.  Thigh  rotation — both  legs—reclining. 

7.  Trunk  elevation — lying — active. 

8.  Right  knee  flexion  and  extension — sitting — re- 
sistive. 

9.  The  same  as  No.  i. 

In  the  first  instance  the  treatment  is  given  to  in- 
crease the  circulation  in  and  around  the  joint,  to  pro- 
mote absorption,  and  to  squeeze  exudations  out  of  the 
joints. 

In  the  second  instance  the  treatment  tends  to  tone 
up  the  whole  system  by  strengthening  the  circulaion 
and  digestive  organs. 

Massage  should  not  he  used  in  any  cases  of  high 
fever,  cancer,  ulcers,  hemorrhages,  infectious  diseases, 
or  diseases  where  the  inflammatory  products  have  as- 
sumed a  quality  injurious  to  the  system,  nor  in  most 
skin  diseases. 


INDEX. 


Abdomen,  massage  of,  51,  52, 
53,  54.  55,  56. 
effects  of   massage  of,  51- 
57. 
Adhesions,     solution     and     re- 
moval of,   15,   16,  11,  28, 
45,   110. 
Ankle-joint,     to     limber     and 
strengthen,    45,     4<^),    80, 
113. 
Arms,    corrective    active    exer- 
cises of,  92. 
circling,   93. 
elevation,  93,  94. 
flexion    and    extension,   95, 

96. 
flinging,  94. 
passive  movements  of  the,  11. 
A.  Manipulations  of  the,  11. 
beating,  Z2i. 
friction,    31. 

circular,  25. 
kneading,  22. 
circular,   24. 
combination,    32. 
muscular,   23. 
muscle   rolling,  31. 
nerve  compression,  30. 
percussion,   ZZ. 
slapping,   31. 
stroking,     centripetal, 

22. 
vibration,   35. 


Arms,  passive  movements  of : 
B.  Rotations,     or     circum- 
duction, of  the,  Zl . 
arm,  38. 
finger,  Zl. 
forearm,  Z7 . 
forward   arm,   41. 
hand,  Zl . 
shoulder,  43. 
vertical  arm,  40. 
resistive    movements    of    the, 

n. 

flexion  and  extension  of 
arm,  linger,  hand,  11,  IZ, 
74,   75. 

lateral   arm   elevation,    11. 

separation  and  closing,  76. 

traction,  1%. 

Back,  massage  of,  58-62. 
Backache,  relieves,  60. 
Bladder,  weakness  of,  63. 
Blood,  circulation,  good  effect 
on,  26-108. 
high  pressure,  130-132. 
I'rain,  derivative   from  the,  36, 

39,  42,  91. 
quieting  eft'ect  on,  71. 

"Charley-horse,"   treatment   of, 

113. 
Chest,  derivative  effect  on,  36, 

40,  42. 

(207) 


208 


INDEX. 


Chest,  expansion  of,  40,  41,  42, 
43,  74-77. 
manipulations  of  the,  49,  50. 
Cold   hands,   treatment   of,   32, 
38. 
feet,  treatment  of,  177. 
Constipation,    good     effect    in, 
47,  48,  51-57,  81,  83,  84. 
useful  in,  88,  89,  98,  102-107. 

Diseases    and    their   treatment, 
109. 
arteriosclerosis,  130,  131,  132. 
constitutional    diseases 
chlorosis  and  anemia,  134, 

135,  136. 
diabetis  mellitus,  140,  141. 
hysteria  and  hypochondria, 

133. 
insomnia,   137,   138,   139. 
neurasthenia,  125,  126,  127. 
diseases    of    the    organs    of 
circulation,   171. 
chronic     heart     diseases, 
171,  172,  173,  174,  175. 
cold  hands  and  feet,  177. 
high  blood-pressure,  130, 

131,  132. 
the    "Schott"    treatment, 
176. 
of  the  organs  of  digestion, 
179. 
appendicitis,  183. 
constipation,  180,  181. 
dyspepsia,  179,  180. 
indigestion    and    bilious- 
ness, 183,  184. 
liver,  hyperemia  of,  182. 
obesity,  184. 


Diseases     of     the     organs     of 
movement,  109-205. 
joints,    stiffness    of,    109, 

110,   111,   112. 
rheumatism,       muscular, 
197,  198. 
joints,   ''arthritis,"  203, 

204,  205. 
lumbago,  200,  201,  203. 
of  arm,  199. 
of  neck,  200. 
scoliosis,    187,    188,    189, 
190,     191,     192,     193, 
194,   195. 
sprains,     113,     114,     115, 

116. 
synovitis,    113,    114,    115, 

116. 
water  on  knee,  113. 
"Charley-horse,"   113. 
of  the   respiratory  organs, 
177. 
bronchialis,  spasmus,  177. 
larynx,   catarrh  of,   177. 
lungs,  catarrh  of,   177. 
congestion  of,   177. 
emphysema  of,    177. 
tuberculosis,   177,    178. 
of  the  urinary  and  sexual 
organs,  185. 
bladder,   chronic   catarrh 

of,  185. 
menstruation,      irregular 

and  painful,  186. 
womb,     chronic     catarrh 
of,  185. 
displacement  of,   186. 
local  diseases,  143. 


IXDEX. 


209 


Diseases,   local,   brain,   conges- 
tion of  the,  143. 
anemia  of  the,  144. 
chorea,  161,  162. 
legs,  cramp  of,  161. 
neuralgia,  sciatic,  163,  170. 
paralysis,     result    of     apo- 
plexy, 144-149. 
infantile,    153-158. 
spine,  congestion   of,   150. 
,        tabes    dorsalis     (locomotor 
ataxia),  150-152. 
writers'  cramp,  160,  161. 

Effects,  physiological,  of  move- 
ments, 15. 

of  active  and  resistive,  16, 
17. 

of  centripetal  stroking,  27. 

of  kneadings,  28,  29,  52, 
53,  54. 

of  manipulations,  26,  27. 

of  nerve  compression,  32, 
33. 

of  passive  movements,  15, 
16. 

of  percussion,  34,  35. 

of  respiratory  movements, 
42,  43. 

Face,   massage  of  the,   67,  68, 

69. 
Flat-foot,  119,  120,  121,   122. 

General  massage,  123,  124,  125. 
prescription     I,     126,     127, 

128. 
prescription    IT,    129. 
prescription   III,   130,   131. 


Head,  bending  of  the,  102. 

flexion  of  the,  71. 

massage  of  the,  64,  65,  66,  67. 

rotation  of  the,  71. 
Heart,     organic     diseases     of, 

171-175. 
Hip-joint,   stiffness  and  weak- 
ness, 47,  81,  87. 

to  limber,  47. 
Hydrarthrus,  treatment  of,  113. 

Indigestion,  good  effect  in,  47, 
51.  53,  55,  89,  99,  101- 
107. 

Insomnia,  good  effect  in,  30, 
31,  58,  60,  61,  66. 

Joints,  stiffness  of,  109,  110, 
111,  112. 

Kneading,    circular,    of    abdo- 
men, 53,  54. 
circular,  of  ann,  24,  25,  28. 

of  leg.  44. 
combination,  of  arm,  32. 

of  leg,  44. 
knuckle,  52. 
muscle,  52,  53. 
muscular,  of  arm,  23,  24,  28. 

of  leg,  44. 

Lameness,     stimulating     effect 
in,  31,  32. 
treatment  of,  33. 
Legs,  manipulation  of  the,  44. 
beating,  44. 
friction,  44. 

kneading,  muscle,  circular, 
combination,   44. 


210 


INDEX. 


Legs,  muscle    rolling,  44. 
nerve  compression,  44. 
percussion,  44. 
slapping,  44. 
stretching  the  sciatic 

nerve,  45. 
stroking,  centripetal,  44. 
vibration,  45. 
corrective,     active     exercises 
of,  97. 
balance    standing,    100. 
bending,  knees,  98. 
charge,  99. 

elevation  of  the,  97,  98, 
99,  101. 
resistive   movements    of   the, 
80. 
elevation  of  the,  83. 
flexion     and      extension, 
foot  and  leg,  80,  81. 
knee,  83. 
separation  of  the,  84,  85, 

86. 
torsion  of  the  leg,  87. 
traction  of  the  knee,  81. 
of  the  leg,  84. 
rotations,  or  circumductions, 
of  the,  45. 
foot  rotation,  45. 

flexion,  46. 
hip  rotation,  48. 
thigh  rotation,  46, 
Liver,  stimulating  effect  on,  56. 
LungE,    stimulating    effect    on, 
36,  40,   41,  42,  43.  49, 
SO,  56. 
diseases  of  the,  177,  178. 
Lymph,  removal  of,  26,  27,  28. 


Massage,  not  to  be  used,  205. 
Muscles,  abdominal,  82,  83,  97. 
to    strengthen,    78,   82,    83, 
84,  89,  104,  105,  107. 
abductor,  of  thigh,  85,  97,98. 
adductor,   of   thigh,  87. 
arm,  74,  79. 

to  strengthen,  12,,  75,  79. 
back,  74,  75,  93,  95,  103. 
to    strengthen,    74,    78,    89, 
90,  95,  100,  104. 
calf  and  foot,  98. 

to  strengthen,  80,  99,   121. 
extensors,  of  leg,  81,  83,  97, 
98. 
of  thigh,  81,  98. 
flexor,  of  leg,  82. 
of  thigh,  82,  97. 
neck,  102. 

Nerve   centers,    stimulation   of, 
2,2,,  59. 
strengthening   of,   50,   60. 
Nerves,  good  effect  on,  31,  32, 
60. 
stimulating    effect    on,    36, 

61. 
to  quiet,  31,  58,  60,  61. 
to  sooth,  31,  58,  60,  61. 
to  stimulate  action  of,  31, 
ZZ,  59,  61. 
Nervous   palpitation,    50. 

Pelvis,  derivative,  from  organs 
of,  47,  63,  81,  84,  86. 
diseases  of,  185. 

Purgative  effect,  47,  48,  51,  52, 
54,  55,  63,  89. 


INDEX. 


211 


Respiration,  good  effect  on,  36, 
42,  50,  89,  93. 
good   iiiovenient    for,   41,  43, 

50,  75,  78,  90. 
stimulating  effect  on,  36,  49, 
50,  94. 
Rheumatism,  197. 
treatment   of   muscular,    199, 
200.  201,  202. 
of  joint,  203,  204,  205. 

Sexual    organs,    weakness    of, 

185. 
Shoulder-joint,  muscles  of,  79. 
stifYness  of,  79,  109. 
to  limber,  38.  93,  96,  104. 
to    strengthen,    79,    93,    96, 
104. 
Shoulders,     to     straighten,    40, 
41,  42,  74,   75,  76,   11, 
93,  94,  100. 
Spine,   good  effect  on,  58,   59, 
60,  61. 


Spine,  to  straighten,  74,  11 ,  89, 

94,  99,  100,  187-195. 
Stomach,  friction  of,  51. 

good  eflfect  on,  51-56. 

kneading  of,  52,  53. 

vibration  of,  55. 

Trunk,   corrective  active  exer- 
cises of,  102. 

chopping  movement,   104. 

circling  of,  106. 

elevation  of,   106,   107. 

flexion  and  extension,   102, 
103,  104. 

harvesting,   104. 

horizontal,  108. 

torsion  of,  105. 
movements  of,  88. 

flexion   and   extension,   89, 
90. 

rotation,  88. 

torsion,  88,  89. 
Throat,    massage    of    the,    64, 
70,  71. 


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